The mechanisms of cancer-associated thrombosis

Patients with cancer may display many types of hemostatic disorders that significantly contribute to morbidity and mortality in this disease. A complex coagulopathy develops in parallel with malignancy and is characterized by activation of clotting mechanisms to different extent in different patients and in different types of tumor. The pathogenesis of hemostatic alterations in cancer is multifactorial; however, the tumor tissue capacity to interact with and activate the host hemostatic system plays an important role. New molecular pathways of regulation of these properties have been recently demonstrated. Intervention strategies to prevent and treat venous thromboembolism (VTE) in cancer patients have been addressed by large RCTs and guidelines for VTE management have been updated. In this review, we will present an updated overview of the complex coagulopathy associated to malignancy and of recent advances in the thrombotic risk assessment of cancer patients.