Prevention of arterial and venous thrombosis in cancer patients

Patients with cancer have prothrombotic and hypercoagulable state, which leads to higher risk for venous thromboembolism and other clinical manifestations of thromboses. Pathophysiology of thrombosis in cancer patients is influenced by many factors, different from patients without malignancy. Tumor cells express tissue factor and other procoagulant factors and during tumors invasive growth, dissemination and metastasis process tumor cells interact with endothelial cells, leukocytes, monocytes and platelets. Increased platelet activation and aggregability as well as changes in coagulation and fibrinolysis are present in cancer and especially in metastatic disease. Higher risk for venous thromboembolism is well known in patients with cancer during hospitalization, in patients with malignancy before, during and after operation, during ambulatory active chemotherapy, as well as in patients with different kinds of adjunctive therapy. Associated complications such as pulmonary embolism and others are associated with the increase of early mortality in these patients. Prevention of venous thromboembolism in this population is recommended in nearly all patients, especially in patients with prior venous thromboembolism or pulmonary embolism. Drugs of choice are low-molecular weight heparins, unfractionated heparin, vitamin K antagonists and fondaparinux. With the evolution of new anticoagulants which are coming to clinical praxis such as dabigatran, we can expect their further use for prevention in cancer patients in the future.