Haemostatic challenges in the cancer patient: Focus on the perioperative period

Cancer patients are at high risk of thrombo-embolism and haemorrhage – which is exacerbated in the perioperative period. The pathogenesis of this haemostatic dysfunction is complex and involves the interplay of multiple factors. A detailed understanding of the disease pathophysiology, including mechanisms of haemostasis and laboratory assessment, is imperative in the decision making. Thrombo-embolism is an important and preventable complication of cancer surgery – with appropriate application of thromboprophylaxis. The key outstanding issues surround timing of initiation, regimen and duration of therapy. A major limitation in both our understanding and our pre-emptive management of the haemostatic dysfunction is a lack of sensitive and specific tests of haemostatic potential that can provide predictive power for risk stratification. Routine laboratory tests do not accurately recognise hyper- or hypocoagulable states, or test the clinical effects of procoagulant or anticoagulant interventions. We need further development of cellular-based assays that incorporate all the components of the haemostatic system.