Cancer-associated thrombosis in the era of precision oncology: Mechanisms, challenges and future directions

Cancer-associated thrombosis (CAT) is a common and life-threatening complication in cancer patients, leading to poor prognosis and reduced survival rate. The pathophysiology process of CAT is driven by a complex interplay of tumor-related process, including tumor-specific genetic mutations, activation of coagulation cascades, multicellular interactions within the tumor microenvironment, and suppression of the fibrinolytic system. Moreover, anticancer therapies, particularly immune checkpoint inhibitors have been shown to further exacerbate this risk. A profound understanding of these mechanisms is essential for therapeutic advancement, necessitating robust preclinical models that accurately replicate the complex pathological features of the disease. This review synthesizes the core mechanisms of CAT, critically evaluates the strategic application of current CAT models, and highlights recent advances in predictive biomarkers, risk assessment models, and emerging therapeutic targets. By integrating mechanistic insights with translational challenges, this review seeks to inform and guide the development of more effective, targeted interventions for CAT.