Venous Thromboembolism in Cancer-related Spinal Cord Injury: Evidence Gaps and a Roadmap for Future Research

Abstract Purpose of Review This review aims to frame venous thromboembolism (VTE) in cancer-related spinal cord injury (crSCI) as a distinct, high-risk clinical entity. We sought to examine existing epidemiologic, mechanistic, and clinical evidence at the intersection of spinal cord injury (SCI) and malignancy, identify gaps in current prevention and treatment paradigms, and define priorities for future research. Recent Findings Recent literature reinforces that SCI and cancer independently confer profound and sustained VTE risk, yet patients with spinal tumors, epidural disease, and recent spinal surgery remain systematically excluded from major anticoagulation trials. No population-based studies directly quantify VTE incidence or outcomes in crSCI, and existing cancer or SCI risk models lack validation in this population. Summary CrSCI represents a biologically plausible “stacked” Virchow triad with likely synergistic thrombotic risk. Current management relies on extrapolation rather than evidence. Dedicated registries, risk models, and inclusive trials, particularly evaluating prophylaxis duration, anticoagulant selection, and bleeding risk, are essential to guide future, data-driven care.