Trends and Updates on the Epidemiology of Cancer Associated Thrombosis: A Systematic Review

Cancer associated thrombosis (CAT) is a significant complication for patients with cancer. This review summarizes an updated epidemiology of CAT in the past decade.

A systematic review was conducted on relevant population cohort studies published 2011-2024.

The 12-month incidence of CAT among patients with unselected cancers is approximately 3-5% (9-fold increase vs. matched non-cancer population); although the risk increases to 6-8% in patients with advanced cancers requiring systemic therapy (20-fold increase vs. matched non-cancer population). Despite improvement in anticoagulation usage and adherence, recurrence risk remains high at 5-8% at 6 months and 7-15% at 12 months. Important clinical predictors of CAT development are cancer type, cancer stage, cancer treatment, prior venous thromboembolism (VTE) history, prolonged hospitalization or immobilization, and obesity. Several clinical risk prediction scores for CAT utilizing the initial Khorana score backbone have been externally validated, and the modified Vienna-CATS (Pabinger 2018) and EHR-CAT (Li 2023) have the highest performance (Area Under the Curve 0.68-0.71), though more studies are needed to ensure adequate implementation and usage of these models.

CAT remains a significant complication for patients with cancer even with modern antineoplastic therapies. We encourage multidisciplinary collaborations between hematologists, oncologists, epidemiologists, and data scientists to ensure the adoption of personalized VTE risk assessment in routine oncologic care.