Cancer: Risk for Thromboembolic Events

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Cancer is a recognized risk for thromboembolic events (TEE) with rates in this population being up to four higher than the general population [1,2]. Indeed, up to 30% of TEE occur in cancer patients [3-5]. These events, in addition to attendant morbidity and mortality contribute additional economic burden to the health care system with costs of hospital management estimated at about $20,000 per patient [6,7]. TEE are held to be the second leading cause of death in cancer patients [8] and patients with TEE over all have poorer outcomes with a 2 fold increase in death rate within 2 years of diagnosis in patients with breast cancer [9]. The spectrum of TEE described in cancer includes, but is not limited to venous thrombo-embolism (VTE), arterial thrombosis, thrombocytic nonbacterial endocarditis and disseminated intravascular coagulopathy (DIC)[10,11]. VTE; including deep vein thrombosis (DVT) and pulmonary embolisms (PEs) represent the majority of TEE [12] and are thus the most commonly commented on.

In addition to risks factors for TEE described in the general medical population, a number of factors peculiar to the cancer patient have been identified as contributing to the hypercoagulable profile. [13]These have been grouped into cancer related, patient related and treatment related factors [14]. Compared to cancer involving other organs like the brain, lungs and pancreas; breast cancer is considered low risk for VTE [15]. However, given the prevalence of breast cancer in the population, it is not surprising that this cohort of patients contribute significantly to the new cases of VTE in the cancer population particularly in the context of advanced disease and chemotherapy [16]. We intend to highlight the role of chemotherapy ...

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... for VTE in breast cancer patients.

Conclusion and Future Perspectives

Important advances continue to be made in uncovering the pathobiology of and risk factors for thromboembolic events in cancer. These advances are providing evidence that support individualizing the management of venous thromboembolism in breast cancer patient on chemotherapy based on risk factors. Even though breast cancer is considered low risk for VTE, incorporating risk assessment models in the outpatient setting may help identify a cohort of patients who would benefit from prophylactic therapy and those who are at increase increased for VTE recurrence. The role of TSOACs in the management of VTE in cancer needs to be further defined. Given the central role of Tissue Factor in the pathogenesis of VTE in cancer, targeting this protein seems logical in the hunt for the perfect anticoagulant.

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