Prediction and management of recurrent venous thromboembolism in patients with cancer

Patients with cancer have an increased risk of venous thromboembolism (VTE), often even while on therapeutic dose of anticoagulation. Recent randomized controlled trials show that the 6-month rate of recurrent VTE is 5-8% during anticoagulation. Multiple risk factors are reported to be associated with recurrent cancer-associated thrombosis, including history of VTE, poor Eastern Cooperative Oncology Group performance status, metastatic diseases, and certain cancer types. Several risk assessment models are derived, but better validation is needed before clinical use. Management of patients with recurrent VTE while on anticoagulation is challenging. Necessary considerations include both the risk of further VTE recurrence and the risk of bleeding. In this review, we will summarize pertinent literature and provide suggestions on the management strategies in patients with recurrent cancer-associated thrombosis.