Improving Outcomes with Prophylactic Anticoagulation in Patients with Cancer: Lessons from the American Society of Clinical Oncology Guidelines
Risk of Venous Thromboembolism in Cancer Patients The risk of venous thromboembolism (VTE) is substantially increased in cancer patients, most notably those with cancers of gastrointestinal origin (1-3). Risk factors for VTE in cancer patients also include hospitalization, systemic chemotherapy with subsequent neutropenia, and presumed infection, older age, and several comorbidities including obesity, pulmonary disease, and renal failure (4). Additional risk factors for VTE in cancer patients include the stage of disease, the type of treatment including hormonal therapy and surgery, and the use of a central venous catheter. More recent studies have also demonstrated a considerable risk of VTE in patients with malignant lymphoma (4,5). The risk of VTE in hospitalized cancer patients appears to be increasing at a concerning rate (4). Although the reason for the apparent rise in the rate of VTE is unknown, increased acuity in hospitalized cancer patients, an increased awareness of diagnosing VTE, and broad use of better, high-resolution computed tomography (CT) imaging methods may all play a role (6-8). A number of new cancer therapies also appear to be associated with an increased risk of VTE (9-11). Likewise, Erythroid-stimulating proteins appear to place patients at increased risk of VTE (3,12).
