Originally published as JCO Early Release 10.1200/JCO.2009.22.3271 on August 31 2009

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Assessing Risk of Venous Thromboembolism in the Patient With Cancer

From the James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, NY.

Corresponding author: Alok A. Khorana, MD, 601 Elmwood Ave, Box 704, Rochester, NY 14642; e-mail: alok_khorana{at}URMC.rochester.edu.

Purpose Patients with cancer are increasingly at risk for venous thromboembolism (VTE). Rates of VTE, however, vary markedly among patients with cancer.

Design This review focuses on recent data derived from population-based, hospital-based, and outpatient cohort studies of patients with cancer that have identified multiple clinical risk factors as well as candidate laboratory biomarkers predictive of VTE.

Results Clinical risk factors for cancer-associated VTE include primary tumor site, stage, initial period after diagnosis, presence and number of comorbidities, and treatment modalities including systemic chemotherapy, antiangiogenic therapy, and hospitalization. Candidate predictive biomarkers include elevated platelet or leukocyte counts, tissue factor, soluble P-selectin, and D-dimer. A recently validated risk model, incorporating some of these factors, can help differentiate patients at high or low risk for developing VTE while receiving chemotherapy.

Conclusion Identifying patients with cancer who are most at risk for VTE is essential to better target thromboprophylaxis, with the eventual goal of reducing the burden as well as the consequences of VTE for patients with cancer.

Supported by grants to A.A.K. from the National Cancer Institute (Grant No. K23 CA120587), the National Heart, Lung and Blood Institute (Grant No. 1R01HL095109-01), and the V Foundation.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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