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Cancer-associated thrombosis and bleeding.

Takayuki Ikezoe1

  • 1Department of Hematology, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 960-1295, Japan. ikezoet@fmu.ac.jp.

International Journal of Hematology
|February 4, 2024
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Summary

Cancer patients face high risks of thrombosis and bleeding due to cancer and treatments. International guidelines recommend anticoagulants for cancer-associated thrombosis (CAT) prevention, but Japan lags in approval.

Keywords:
BleedingCancer-associated thrombosisPodoplaninTissue factorVirchow’s triad

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Area of Science:

  • Oncology
  • Hematology
  • Vascular Biology

Background:

  • Cancer patients exhibit Virchow's triad: hypercoagulability, endothelial injury, and venous stasis, increasing thrombosis risk.
  • Cancer cells express procoagulant factors (tissue factor, podoplanin); treatments induce endothelial damage; immobility causes venous stasis.
  • Cancer patients are also prone to bleeding from complications like disseminated intravascular coagulation and chemotherapy-induced thrombocytopenia.

Purpose of the Study:

  • To highlight the significant risk of cancer-associated thrombosis (CAT) in cancer patients.
  • To discuss the challenges in managing CAT, including bleeding risks.
  • To address the disparity in CAT treatment guidelines between Japan and international standards.

Main Methods:

  • Review of existing literature on cancer-associated thrombosis pathophysiology.
  • Analysis of clinical guidelines from international societies (ASCO, ITAC).
  • Comparison of treatment recommendations for CAT prevention and management.

Main Results:

  • Cancer patients are at high risk for thrombosis due to disease and treatment factors.
  • Established international guidelines recommend anticoagulants (LMWH, DOACs) for CAT prevention.
  • Current Japanese drug approvals do not align with these international recommendations for CAT.

Conclusions:

  • Cancer-associated thrombosis (CAT) poses a significant clinical challenge.
  • International guidelines offer evidence-based strategies for CAT prevention and management.
  • A critical gap exists in Japan regarding the approval of recommended anticoagulant therapies for CAT, necessitating regulatory action.