Our scientific director Anna Falanga and senior researcher Marina Marchetti summarized for the prestigious international journal Journal of Thrombosis and Haemostasis the progress made over the past two decades.
Incidence
The incidence of venous thrombohemobolism (VTE) is significantly higher (7- to 11-fold), in people with cancer compared to the general population. However, it may vary depending on several factors, including cancer status (active or inactive), site, stage of disease (advanced or limited), concomitant anticancer therapies, surgical procedures, and several patient-related risk factors.
Awareness
As much as it has become a topic of increasing study, there is an equal need to continue educating the general population and cancer patients about the risks, symptoms, and signs of VTE. Recent patient surveys indicate a lack of awareness regarding thrombosis-associated cancer, including recognition of appropriate signs and symptoms. It is also important to educate cancer patients with asymptomatic VTE about the dangers or recurrent events.
Biomarkers
Many cancer patients have elevated levels of markers that indicate activation of blood clotting, even if they do not yet have overt thrombosis. Research has shown that these biomarkers can vary among tumor types and worsen with disease progression.
Risk assessment models
Recent studies (such as the HYPERCAN study carried out by ARTET Foundation for several years) are examining the potential of biomarkers for the diagnosis or prediction of venous or arterial thrombosis in cancer patients.These models are important for preventing thrombosis-related complications that can have a significant impact on morbidity and mortality in cancer patients.
Treatment
When a patient with cancer is admitted for an acute illness, it is advisable to consider prophylactic dose heparin therapy to prevent thrombosis. This recommendation is based on three controlled scientific studies that demonstrated the efficacy and safety of different heparins in these patients.
Outpatient cancer therapy
The risk of venous thromboembolism (VTE) is high in cancer patients starting cancer therapy, but theLINK guidelines do not recommend routine thromboprophylaxis for all patients. Assessment of risk level is important in deciding whether to administer thromboprophylaxis with heparin or direct oral anticoagulant drugs (DOACs). Major guidelines recommend thromboprophylaxis for patients at high risk of VTE. The choice of thromboprophylaxis should be based on the patient’s level of risk for thrombosis and bleeding as well as clinical judgment and preference.
Thrombosis treatment in tumors
The treatment of thrombosis in patients with cancer can be divided into three phases, and the use of DOACs or heparins is recommended by guidelines. The choice of the type of anticoagulant should be made considering the risk of bleeding, the type of cancer, and potential drug interactions. Ongoing research seeks to develop drugs with minimal bleeding risk. It is important to consult your medic (oncologist or expert in hemostasis and thrombosis) or to assess your individual risk.