Cancer-Associated Thromboembolic Disease and the Evolution of Management

Venous thromboembolism remains a serious complication for patients with cancer, affecting survival and disrupting cancer-directed therapy. Cancer-associated thrombosis unfolds due to a combination of factors, including systemic inflammation and intrinsic patient and tumor characteristics. Tissue factor expression, cytokine release, and neutrophil traps increase prothrombotic risk. The burden is also higher in cases of immobility, surgery, the use of central venous catheters, chemotherapy, and immunotherapy, which increase the risk. Pancreatic, gastric, lung, and brain cancers have especially high rates of venous thromboembolism. The Khorana score is still often used to estimate risk, although newer tools using biomarkers and machine learning are showing promise in recent research. Direct oral anticoagulants seem to be the drug of choice for most patients. Gastrointestinal and genitourinary malignancies pose a bigger challenge given their higher risk for bleeding, requiring an individualized approach for these patients. Other situations requiring special attention are thrombocytopenia and patients with kidney and liver dysfunction. More research is needed on immunotherapy-associated thrombosis and biomarkers to contribute to a better understanding of pathophysiology, develop more effective diagnostic mechanisms, and improve prevention and quality of life.