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ASCO Educational Book; 2009
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Incidence and Prevention of Cancer-associated Thrombosis

Alok A. Khorana, MD, and Gary H. Lyman, MD, MPH, FRCP (Edin)

From the James P. Wilmot Cancer Center (Dr. Khorana), and the Department of Medicine, University of Rochester, Rochester, NY, Duke University and the Duke Comprehensive Cancer Center, Durham, NC (Dr. Lyman)

Dr. Khorana is supported by grants from the National Cancer Institute (5K23CA120587-03); the National Heart, Lung and Blood Institute (1R01HL095109-01); and the V Foundation. Dr. Lyman is supported by a grant from the National Heart, Lung and Blood Institute (1R01HL095109-01).

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Alok A. Khorana, MD, 601 Elmwood Avenue, Box 704, Rochester, NY 14642; e-mail: alok_khorana{at}urmc.rochester.edu

Overview: Venous thromboembolism (VTE) is common in patients with cancer, especially those receiving active treatment. Risk factors for VTE include age, primary site of cancer, stage, comorbidities, and therapeutic modalities, including surgery, chemotherapy, and antiangiogenic agents. Candidate biomarkers for VTE are being actively investigated and include platelet and leukocyte counts, tissue factor, and P-selectin. A risk model for predicting chemotherapy-associated VTE has recently been validated. Thromboprophylaxis in the hospitalized and surgical settings should include low-molecular weight heparins or unfractionated heparin unless contraindicated. In the outpatient setting, routine anticoagulant prophylaxis is recommended only for patients with myeloma receiving thalidomide- or lenalidomide-based regimens. However, ongoing investigations of thromboprophylaxis in high-risk ambulatory patients with cancer may affect clinical practice in the near future.