Cancer-associated thrombosis in cholangiocarcinoma: Exploring a phenotype of tumor aggressiveness

Cholangiocarcinoma (CCA) is the liver malignancy with the most rapid increase in incidence and lethality in recent years. Venous thromboembolism (VTE) is a common complication of the cancer-associated hypercoagulable state, which may incite tumor progression and dissemination, thereby increasing cancer-related morbidity and mortality. Compared to other cancer types, occurrence of VTE in CCA has been underestimated, though recent evidence indicates it may behave as prognostic factor of worst outcome. Given the need for novel predictive scores and treatment approaches when VTE occurs, identifying subgroups of patients with CCA who would benefit from thromboprophylaxis without increasing the risk of bleeding is a crucial but still neglected aspect of the management. The aim of this review is to summarize current observations on the clinical significance, prediction, risk assessment and the underlying mechanisms of cancer-induced thrombogenesis in CCA, as well as to identify research areas ripe for prioritization in the near future.