Thrombotic complications of pancreatic cancer: classical knowledge revisited

This paper is an updated review of a classical clinical subject: the association between deep vein thrombosis and pancreatic cancer. Recent epidemiological data support the empirical observation of Trousseau that digestive cancer may induce deep vein thrombosis. Pancreatic cancer is among the most common malignancies associated with thrombosis, due to the fact that cancer may induce the activation of the coagulation. There are genetic factors linked to this association. Cancer patients carrying the factor V Leiden mutation and the prothrombin 20210A mutation have increased risk to develop thrombosis. Reciprocally, it has been speculated that deep vein thrombosis or pulmonary embolism could represent a warning sign for a latent cancer. The practical question about this association is: shall we recommend searching for pancreatic and other cancers in all patients with thrombosis? Present data show that the strategy to look for such malignancies in patients with thrombosis on a routine base is not cost-effective. Oncological screening should be limited to patients at risk to develop cancer. Patients with pancreatic cancer, as with other visceral cancers, should be submitted to a prophylactic strategy to prevent thrombosis: therapy with low-molecular-weight heparin for several weeks was beneficial in several trials.