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Venous Thromboembolism and Cancer

  • Cardio-Oncology (SA Francis and RB Morgan, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review aims to summarize the epidemiology, current pathophysiologic understanding, and state-of-the-art treatment of venous thromboembolism (VTE) in cancer patients.

Recent Findings

The risk of VTE varies among cancer patients. Recently introduced prediction models better identify those at high risk of VTE. New mechanisms underlying hypercoagulability in cancer have been uncovered. Initial data on the efficacy of direct oral anticoagulants (DOACs) compared with low-molecular weight heparin to treat VTE in patients with cancer are promising. However, they may be associated with higher risk of gastrointestinal bleeding.

Summary

VTE causes significant morbidity and mortality in cancer patients. Our understanding of the mechanisms of VTE, including those associated with cancer treatments, has significantly grown. The assessment of the benefit/risk balance of VTE treatment remains challenging in many patients with cancer. The introduction of DOACs has expanded treatment options, but knowledge on their efficacy and safety is incomplete.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Trousseau ACJ, Bazire PV. Lectures on clinical medicine: delivered at the hotel-Dieu. Paris: New Sydenham Society; 1872.

    Google Scholar 

  2. • Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712–23. https://doi.org/10.1182/blood-2013-04-460121. This is an excellent summary of the data regarding the incidence, risk factors, and prognosis of VTE in cancer with an emphasis on the differential risk based on tumor type.

    Article  CAS  PubMed  Google Scholar 

  3. Gussoni G, Frasson S, La Regina M, Di Micco P, Monreal M, Investigators R. Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer. Findings from the RIETE registry. Thromb Res. 2013;131(1):24–30. https://doi.org/10.1016/j.thromres.2012.10.007.

    Article  CAS  PubMed  Google Scholar 

  4. Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Arch Intern Med. 2007;167(14):1471–5. https://doi.org/10.1001/archinte.167.14.1471.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Walker AJ, Card TR, West J, Crooks C, Grainge MJ. Incidence of venous thromboembolism in patients with cancer - a cohort study using linked United Kingdom databases. Eur J Cancer. 2013;49(6):1404–13. https://doi.org/10.1016/j.ejca.2012.10.021.

    Article  PubMed  Google Scholar 

  6. Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715–22. https://doi.org/10.1001/jama.293.6.715.

    Article  CAS  PubMed  Google Scholar 

  7. Horsted F, West J, Grainge MJ. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med. 2012;9(7):e1001275. https://doi.org/10.1371/journal.pmed.1001275.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost. 2006;4(3):529–35. https://doi.org/10.1111/j.1538-7836.2006.01804.x.

    Article  CAS  PubMed  Google Scholar 

  9. Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States. Cancer. 2013;119(3):648–55. https://doi.org/10.1002/cncr.27772.

    Article  CAS  PubMed  Google Scholar 

  10. Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166(4):458–64. https://doi.org/10.1001/archinte.166.4.458.

    Article  PubMed  Google Scholar 

  11. Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846–50. https://doi.org/10.1056/NEJM200012213432504.

    Article  CAS  PubMed  Google Scholar 

  12. Gade IL, Braekkan S, Naess IA, Hansen JB, Rosendaal F, Cannegieter S, et al. Epidemiology of venous thromboembolism in hematological cancers: the Scandinavian thrombosis and Cancer (STAC) cohort. Thromb Res. 2017;158:157–60. https://doi.org/10.1016/j.thromres.2017.09.002.

    Article  CAS  PubMed  Google Scholar 

  13. Falanga A, Marchetti M. Venous thromboembolism in the hematologic malignancies. J Clin Oncol. 2009;27(29):4848–57. https://doi.org/10.1200/JCO.2009.22.8197.

    Article  CAS  PubMed  Google Scholar 

  14. • Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902–7. https://doi.org/10.1182/blood-2007-10-116327. This study established the Khorana score, which incorporates patient-specific risk-factors and tumor-specific risk factors in outpatients starting chemotherapy. The predictive power of this score can be enhanced through addition of biomarker measurement.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ay C, Dunkler D, Marosi C, Chiriac AL, Vormittag R, Simanek R, et al. Prediction of venous thromboembolism in cancer patients. Blood. 2010;116(24):5377–82. https://doi.org/10.1182/blood-2010-02-270116.

    Article  CAS  PubMed  Google Scholar 

  16. Pabinger I, van Es N, Heinze G, Posch F, Riedl J, Reitter EM, et al. A clinical prediction model for cancer-associated venous thromboembolism: a development and validation study in two independent prospective cohorts. Lancet Haematol. 2018;5:e289–98. https://doi.org/10.1016/S2352-3026(18)30063-2.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Khorana AA, Rubens D, Francis CW. Screening high-risk cancer patients for VTE: a prospective observational study. Thromb Res. 2014;134(6):1205–7. https://doi.org/10.1016/j.thromres.2014.09.016.

    Article  CAS  PubMed  Google Scholar 

  18. Imberti D, Agnelli G, Ageno W, Moia M, Palareti G, Pistelli R, et al. Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER registry. Haematologica. 2008;93(2):273–8. https://doi.org/10.3324/haematol.11458.

    Article  PubMed  Google Scholar 

  19. Martinelli I, De Stefano V. Rare thromboses of cerebral, splanchnic and upper-extremity veins. A narrative review. Thromb Haemost. 2010;103(6):1136–44. https://doi.org/10.1160/TH09-12-0873.

    Article  CAS  PubMed  Google Scholar 

  20. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5(3):632–4. https://doi.org/10.1111/j.1538-7836.2007.02374.x.

    Article  CAS  PubMed  Google Scholar 

  21. Trujillo-Santos J, Martos FM, Font C, Farge-Bancel D, Rosa V, Lorenzo A, et al. Analysis of clinical factors affecting the rates of fatal pulmonary embolism and bleeding in cancer patients with venous thromboembolism. Heliyon. 2017;3(1):e00229. https://doi.org/10.1016/j.heliyon.2016.e00229.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schulman S, Zondag M, Linkins L, Pasca S, Cheung YW, de Sancho M, et al. Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. J Thromb Haemost. 2015;13(6):1010–8. https://doi.org/10.1111/jth.12955.

    Article  CAS  PubMed  Google Scholar 

  23. Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484–8. https://doi.org/10.1182/blood-2002-01-0108.

    Article  CAS  PubMed  Google Scholar 

  24. Trujillo-Santos J, Nieto JA, Tiberio G, Piccioli A, Di Micco P, Prandoni P, et al. Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE registry. Thromb Haemost. 2008;100(3):435–9.

    Article  CAS  PubMed  Google Scholar 

  25. Louzada ML, Carrier M, Lazo-Langner A, Dao V, Kovacs MJ, Ramsay TO, et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation. 2012;126(4):448–54. https://doi.org/10.1161/CIRCULATIONAHA.111.051920.

    Article  PubMed  Google Scholar 

  26. den Exter PL, Kooiman J, Huisman MV. Validation of the Ottawa prognostic score for the prediction of recurrent venous thromboembolism in patients with cancer-associated thrombosis. J Thromb Haemost. 2013;11(5):998–1000. https://doi.org/10.1111/jth.12192.

    Article  CAS  Google Scholar 

  27. Hisada Y, Mackman N. Cancer-associated pathways and biomarkers of venous thrombosis. Blood. 2017;130(13):1499–506. https://doi.org/10.1182/blood-2017-03-743211.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Blix K, Jensvoll H, Braekkan SK, Hansen JB. White blood cell count measured prior to cancer development is associated with future risk of venous thromboembolism—the Tromso study. PLoS One. 2013;8(9):e73447. https://doi.org/10.1371/journal.pone.0073447.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Demers M, Wagner DD. NETosis: a new factor in tumor progression and cancer-associated thrombosis. Semin Thromb Hemost. 2014;40(3):277–83. https://doi.org/10.1055/s-0034-1370765.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Savchenko AS, Martinod K, Seidman MA, Wong SL, Borissoff JI, Piazza G, et al. Neutrophil extracellular traps form predominantly during the organizing stage of human venous thromboembolism development. J Thromb Haemost. 2014;12(6):860–70. https://doi.org/10.1111/jth.12571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Demers M, Krause DS, Schatzberg D, Martinod K, Voorhees JR, Fuchs TA, et al. Cancers predispose neutrophils to release extracellular DNA traps that contribute to cancer-associated thrombosis. Proc Natl Acad Sci U S A. 2012;109(32):13076–81. https://doi.org/10.1073/pnas.1200419109.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Simanek R, Vormittag R, Ay C, Alguel G, Dunkler D, Schwarzinger I, et al. High platelet count associated with venous thromboembolism in cancer patients: results from the Vienna Cancer and thrombosis study (CATS). J Thromb Haemost. 2010;8(1):114–20. https://doi.org/10.1111/j.1538-7836.2009.03680.x.

    Article  CAS  PubMed  Google Scholar 

  33. Khorana AA, Francis CW, Culakova E, Lyman GH. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer. 2005;104(12):2822–9. https://doi.org/10.1002/cncr.21496.

    Article  PubMed  Google Scholar 

  34. Stone RL, Nick AM, McNeish IA, Balkwill F, Han HD, Bottsford-Miller J, et al. Paraneoplastic thrombocytosis in ovarian cancer. N Engl J Med. 2012;366(7):610–8. https://doi.org/10.1056/NEJMoa1110352.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Geddings JE, Mackman N. Tumor-derived tissue factor-positive microparticles and venous thrombosis in cancer patients. Blood. 2013;122(11):1873–80. https://doi.org/10.1182/blood-2013-04-460139.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Thaler J, Ay C, Mackman N, Bertina RM, Kaider A, Marosi C, et al. Microparticle-associated tissue factor activity, venous thromboembolism and mortality in pancreatic, gastric, colorectal and brain cancer patients. J Thromb Haemost. 2012;10(7):1363–70. https://doi.org/10.1111/j.1538-7836.2012.04754.x.

    Article  CAS  PubMed  Google Scholar 

  37. Regina S, Valentin JB, Lachot S, Lemarie E, Rollin J, Gruel Y. Increased tissue factor expression is associated with reduced survival in non-small cell lung cancer and with mutations of TP53 and PTEN. Clin Chem. 2009;55(10):1834–42. https://doi.org/10.1373/clinchem.2009.123695.

    Article  CAS  PubMed  Google Scholar 

  38. Rong Y, Post DE, Pieper RO, Durden DL, Van Meir EG, Brat DJ. PTEN and hypoxia regulate tissue factor expression and plasma coagulation by glioblastoma. Cancer Res. 2005;65(4):1406–13. https://doi.org/10.1158/0008-5472.CAN-04-3376.

    Article  CAS  PubMed  Google Scholar 

  39. Langer F, Bokemeyer C. Crosstalk between cancer and haemostasis. Implications for cancer biology and cancer-associated thrombosis with focus on tissue factor. Hamostaseologie. 2012;32(2):95–104. https://doi.org/10.5482/ha-1160.

    Article  CAS  PubMed  Google Scholar 

  40. Ay C, Simanek R, Vormittag R, Dunkler D, Alguel G, Koder S, et al. High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and thrombosis study (CATS). Blood. 2008;112(7):2703–8. https://doi.org/10.1182/blood-2008-02-142422.

    Article  CAS  PubMed  Google Scholar 

  41. Nuver J, De Haas EC, Van Zweeden M, Gietema JA, Meijer C. Vascular damage in testicular cancer patients: a study on endothelial activation by bleomycin and cisplatin in vitro. Oncol Rep. 2010;23(1):247–53.

    CAS  PubMed  Google Scholar 

  42. Sonpavde G, Je Y, Schutz F, Galsky MD, Paluri R, Rosenberg JE, et al. Venous thromboembolic events with vascular endothelial growth factor receptor tyrosine kinase inhibitors: a systematic review and meta-analysis of randomized clinical trials. Crit Rev Oncol Hematol. 2013;87(1):80–9. https://doi.org/10.1016/j.critrevonc.2012.12.006.

    Article  PubMed  Google Scholar 

  43. Nalluri SR, Chu D, Keresztes R, Zhu X, Wu S. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis. JAMA. 2008;300(19):2277–85. https://doi.org/10.1001/jama.2008.656.

    Article  CAS  PubMed  Google Scholar 

  44. Swystun LL, Mukherjee S, Liaw PC. Breast cancer chemotherapy induces the release of cell-free DNA, a novel procoagulant stimulus. J Thromb Haemost. 2011;9(11):2313–21. https://doi.org/10.1111/j.1538-7836.2011.04465.x.

    Article  CAS  PubMed  Google Scholar 

  45. Knight R, DeLap RJ, Zeldis JB. Lenalidomide and venous thrombosis in multiple myeloma. N Engl J Med. 2006;354(19):2079–80. https://doi.org/10.1056/NEJMc053530.

    Article  CAS  PubMed  Google Scholar 

  46. Zangari M, Anaissie E, Barlogie B, Badros A, Desikan R, Gopal AV, et al. Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy. Blood. 2001;98(5):1614–5.

    Article  CAS  PubMed  Google Scholar 

  47. Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003;21(19):3665–75. https://doi.org/10.1200/JCO.2003.08.008.

    Article  PubMed  Google Scholar 

  48. Agnelli G, Gussoni G, Bianchini C, Verso M, Mandala M, Cavanna L, et al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study. Lancet Oncol. 2009;10(10):943–9. https://doi.org/10.1016/S1470-2045(09)70232-3.

    Article  CAS  PubMed  Google Scholar 

  49. Agnelli G, George DJ, Kakkar AK, Fisher W, Lassen MR, Mismetti P, et al. Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med. 2012;366(7):601–9. https://doi.org/10.1056/NEJMoa1108898.

    Article  CAS  PubMed  Google Scholar 

  50. Maraveyas A, Waters J, Roy R, Fyfe D, Propper D, Lofts F, et al. Gemcitabine versus gemcitabine plus dalteparin thromboprophylaxis in pancreatic cancer. Eur J Cancer. 2012;48(9):1283–92. https://doi.org/10.1016/j.ejca.2011.10.017.

    Article  CAS  PubMed  Google Scholar 

  51. Riess HPU, Opitz B, Stauch M, Reitzig P, Hahnfeld S, et al. A prospective, randomized trial of simultaneous pancreatic cancer treatment with enoxaparin and chemotherapy: final results of the CONKO-004 trial. J Clin Oncol. 2010;28(15_suppl).

    Article  Google Scholar 

  52. Haas SK, Freund M, Heigener D, Heilmann L, Kemkes-Matthes B, von Tempelhoff GF, et al. Low-molecular-weight heparin versus placebo for the prevention of venous thromboembolism in metastatic breast cancer or stage III/IV lung cancer. Clin Appl Thromb Hemost. 2012;18(2):159–65. https://doi.org/10.1177/1076029611433769.

    Article  CAS  PubMed  Google Scholar 

  53. Perry JR, Julian JA, Laperriere NJ, Geerts W, Agnelli G, Rogers LR, et al. PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost. 2010;8(9):1959–65. https://doi.org/10.1111/j.1538-7836.2010.03973.x.

    Article  CAS  PubMed  Google Scholar 

  54. Palumbo A, Cavo M, Bringhen S, Zamagni E, Romano A, Patriarca F, et al. Aspirin, warfarin, or enoxaparin thromboprophylaxis in patients with multiple myeloma treated with thalidomide: a phase III, open-label, randomized trial. J Clin Oncol. 2011;29(8):986–93. https://doi.org/10.1200/JCO.2010.31.6844.

    Article  CAS  PubMed  Google Scholar 

  55. Larocca A, Cavallo F, Bringhen S, Di Raimondo F, Falanga A, Evangelista A, et al. Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide. Blood. 2012;119(4):933–9; quiz 1093. https://doi.org/10.1182/blood-2011-03-344333.

    Article  CAS  PubMed  Google Scholar 

  56. Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline update 2014. J Clin Oncol. 2015;33(6):654–6. https://doi.org/10.1200/JCO.2014.59.7351.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. •• Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146–53. https://doi.org/10.1056/NEJMoa025313. This study established the basis for superiority of LMWH over warfarin for the treatment of VTE in cancer. At 6 months, treatment with dalteparin was associated with a significantly lower rate of VTE recurrence compared with warfarin, with no difference in major bleeding.

    Article  CAS  PubMed  Google Scholar 

  58. Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R, et al. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med. 2006;119(12):1062–72. https://doi.org/10.1016/j.amjmed.2006.02.022.

    Article  CAS  PubMed  Google Scholar 

  59. Meyer G, Marjanovic Z, Valcke J, Lorcerie B, Gruel Y, Solal-Celigny P, et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med. 2002;162(15):1729–35.

    Article  CAS  PubMed  Google Scholar 

  60. Deitcher SR, Kessler CM, Merli G, Rigas JR, Lyons RM, Fareed J, et al. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost. 2006;12(4):389–96. https://doi.org/10.1177/1076029606293692.

    Article  CAS  PubMed  Google Scholar 

  61. Francis CW, Kessler CM, Goldhaber SZ, Kovacs MJ, Monreal M, Huisman MV, et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN study. J Thromb Haemost. 2015;13(6):1028–35. https://doi.org/10.1111/jth.12923.

    Article  CAS  PubMed  Google Scholar 

  62. Lee AYY, Kamphuisen PW, Meyer G, Bauersachs R, Janas MS, Jarner MF, et al. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active Cancer: a randomized clinical trial. JAMA. 2015;314(7):677–86. https://doi.org/10.1001/jama.2015.9243.

    Article  CAS  PubMed  Google Scholar 

  63. van der Hulle T, den Exter PL, Kooiman J, van der Hoeven JJ, Huisman MV, Klok FA. Meta-analysis of the efficacy and safety of new oral anticoagulants in patients with cancer-associated acute venous thromboembolism. J Thromb Haemost. 2014;12(7):1116–20. https://doi.org/10.1111/jth.12605.

    Article  CAS  PubMed  Google Scholar 

  64. Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615–24. https://doi.org/10.1056/NEJMoa1711948.

    Article  CAS  PubMed  Google Scholar 

  65. Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;JCO2018788034. https://doi.org/10.1200/JCO.2018.78.8034.

    Article  PubMed  Google Scholar 

  66. van Es N, Le Gal G, Otten HM, Robin P, Piccioli A, Lecumberri R, et al. Screening for occult cancer in patients with unprovoked venous thromboembolism: a systematic review and meta-analysis of individual patient data. Ann Intern Med. 2017;167(6):410–7. https://doi.org/10.7326/M17-0868.

    Article  PubMed  Google Scholar 

  67. Carrier M, Lazo-Langner A, Shivakumar S, Tagalakis V, Zarychanski R, Solymoss S, et al. Screening for occult Cancer in unprovoked venous thromboembolism. N Engl J Med. 2015;373(8):697–704. https://doi.org/10.1056/NEJMoa1506623.

    Article  CAS  PubMed  Google Scholar 

  68. Robin P, Le Roux PY, Planquette B, Accassat S, Roy PM, Couturaud F, et al. Limited screening with versus without (18)F-fluorodeoxyglucose PET/CT for occult malignancy in unprovoked venous thromboembolism: an open-label randomised controlled trial. Lancet Oncol. 2016;17(2):193–9. https://doi.org/10.1016/S1470-2045(15)00480-5.

    Article  PubMed  Google Scholar 

  69. Jara-Palomares L, Otero R, Jimenez D, Carrier M, Tzoran I, Brenner B, et al. Development of a risk prediction score for occult Cancer in patients with VTE. Chest. 2017;151(3):564–71. https://doi.org/10.1016/j.chest.2016.10.025.

    Article  PubMed  Google Scholar 

  70. Donato J, Campigotto F, Uhlmann EJ, Coletti E, Neuberg D, Weber GM, et al. Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study. Blood. 2015;126(4):494–9. https://doi.org/10.1182/blood-2015-02-626788.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Mantia C, Uhlmann EJ, Puligandla M, Weber GM, Neuberg D, Zwicker JI. Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood. 2017;129(25):3379–85. https://doi.org/10.1182/blood-2017-02-767285.

    Article  CAS  PubMed  Google Scholar 

  72. Zwicker JI, Karp Leaf R, Carrier M. A meta-analysis of intracranial hemorrhage in patients with brain tumors receiving therapeutic anticoagulation. J Thromb Haemost. 2016;14(9):1736–40. https://doi.org/10.1111/jth.13387.

    Article  CAS  PubMed  Google Scholar 

  73. Shinagare AB, Guo M, Hatabu H, Krajewski KM, Andriole K, Van den Abbeele AD, et al. Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer. 2011;117(16):3860–6. https://doi.org/10.1002/cncr.25941.

    Article  PubMed  Google Scholar 

  74. Font C, Farrus B, Vidal L, Caralt TM, Visa L, Mellado B, et al. Incidental versus symptomatic venous thrombosis in cancer: a prospective observational study of 340 consecutive patients. Ann Oncol. 2011;22(9):2101–6. https://doi.org/10.1093/annonc/mdq720.

    Article  CAS  PubMed  Google Scholar 

  75. Bach AG, Schmoll HJ, Beckel C, Behrmann C, Spielmann RP, Wienke A, et al. Pulmonary embolism in oncologic patients: frequency and embolus burden of symptomatic and unsuspected events. Acta Radiol. 2014;55(1):45–53. https://doi.org/10.1177/0284185113491569.

    Article  PubMed  Google Scholar 

  76. den Exter PL, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol. 2011;29(17):2405–9. https://doi.org/10.1200/JCO.2010.34.0984.

    Article  Google Scholar 

  77. O'Connell C, Razavi P, Ghalichi M, Boyle S, Vasan S, Mark L, et al. Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost. 2011;9(2):305–11. https://doi.org/10.1111/j.1538-7836.2010.04114.x.

    Article  CAS  PubMed  Google Scholar 

  78. Di Nisio M, Lee AY, Carrier M, Liebman HA, Khorana AA. Subcommittee on H et al. diagnosis and treatment of incidental venous thromboembolism in cancer patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2015;13(5):880–3. https://doi.org/10.1111/jth.12883.

    Article  PubMed  Google Scholar 

  79. van der Hulle T, den Exter PL, Planquette B, Meyer G, Soler S, Monreal M, et al. Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients. J Thromb Haemost. 2016;14(1):105–13. https://doi.org/10.1111/jth.13172.

    Article  PubMed  Google Scholar 

  80. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–52. https://doi.org/10.1016/j.chest.2015.11.026.

    Article  PubMed  Google Scholar 

  81. Galanaud JP, Sevestre MA, Pernod G, Genty C, Richelet S, Kahn SR, et al. Long-term outcomes of cancer-related isolated distal deep vein thrombosis: the OPTIMEV study. J Thromb Haemost. 2017;15(5):907–16. https://doi.org/10.1111/jth.13664.

    Article  PubMed  Google Scholar 

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Correspondence to Umberto Campia.

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Schmaier, A.A., Ambesh, P. & Campia, U. Venous Thromboembolism and Cancer. Curr Cardiol Rep 20, 89 (2018). https://doi.org/10.1007/s11886-018-1034-3

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