Risk stratification for cancer-associated venous thromboembolism

The risk of venous thromboembolism (VTE) is elevated in cancer, and thrombosis is the second leading cause of death in patients with malignancy. Many risk factors for cancer-associated thrombosis have been identified. These include patient-associated factors such as age, obesity and medical comorbidities; cancer-associated factors such as site and stage of cancer; and treatment-associated factors, particularly chemotherapy and hospitalization. In addition, several candidate biomarkers for cancer-associated thrombosis have been identified recently. Despite the high rate and significant impact of VTE in cancer outpatients, prior attempts at thromboprophylaxis in this population have not consistently demonstrated a benefit. This chapter will focus on risk stratification approaches, including a recently developed predictive model which can be used to identify those patients at highest risk. This model-based approach may have a significant impact on cancer-related morbidity, mortality and cost of care by directing targeted thromboprophylaxis in the future.