Does cancer increase the risk of thrombosis? Here are 5 things you should know

Cancer and sometimes its treatment can lead to changes in blood clotting or damage to blood vessels in your body. People are concerned that this may increase the risk of thrombosis, which occurs in both arteries and veins. Dr Roopen Arya, Professor of Thrombosis and Hemostasis at King’s College Hospital, London, gives us a more in-depth look at the topic so you can assess the real risk of thrombosis.

  1. Does cancer cause thrombosis?

Cancer is strongly linked to blood clots. Venous clots are more common, called venous thromboembolism or VTE, which includes deep vein thrombosis (DVT) in the limbs and pulmonary embolism (PE) in the lungs. In order to determine the risk of thrombosis, you should take into account aspects such as old age, obesity or a history of VTE in combination with factors related to the cancer and its treatment.

About one in six cancer patients develops VTE, and VTE is the second leading cause of death in cancer patients after cancer itself.

  1. Who is most at risk?

Cancer of the pancreas, brain and stomach are considered to have a higher risk of thrombosis, while breast and prostate cancer are relatively less. More advanced cancer or cancer that has spread also carries a higher risk of clots. Treatment for cancer can also increase the risk of clots, whether from hospitalization, surgery, central venous catheters, or cancer drugs. Some chemotherapy drugs such as platinum-based agents have a higher risk, as are drugs that modify the immune system such as thalidomide. Medicines that affect hormone receptors such as tamoxifen used for breast cancer can also increase the risk.

  1. Warning signs to watch out for

Almost one in 10 VTE events is cancer-related, so it is important that doctors caring for the VTE patient are vigilant and screen for cancer if there are any suspicious signs, especially in older patients.

  • DVT typically affects the legs, causing swelling, warmth, and tenderness in the legs, although sometimes there are very few symptoms.
  • DVT can also affect the arm, particularly in breast cancer or typically in central venous catheter thrombosis. A blood clot can break away from the DVT and travel to the lungs, causing PE.
  • Patients with PE usually have shortness of breath and / or chest pain and sometimes coughing up blood.

risk of cancer and thrombosis

  1. How to avoid blood clots?

When cancer patients are hospitalized, the risk of thrombosis is further increased. This risk is reduced by giving patients injections of a blood thinner called low molecular weight heparin (LMWH). These injections are usually given into the skin of the stomach once a day during hospitalization. In some cases, especially after major cancer surgery, injections may be given for a few weeks after discharge to further reduce the risk of VTE.

Generally, cancer patients at home do not need anticoagulants for the prevention of blood clots, but some cases could benefit from this approach. Recent studies show that oral anticoagulants called direct oral anticoagulants (DOACs) could be used to prevent VTE in some high-risk cancer patients.

  1. Treatment options

In recent years, injections of LMWH (usually enoxaparin or dalteparin) have been the main treatment for cancer-associated thrombosis because they are superior to traditional oral therapy with warfarin. LMWHs are better absorbed and interactions with cancer treatments are minimal. More recent studies have shown that oral DOA drugs such as edoxaban, rivaroxaban, or apixaban are safe and effective in some patients with cancer-associated thrombosis.

Therefore, the treatment of thrombosis in cancer patients now often begins with LMWH with the option of later switching to a tablet. Usually, VTE is treated with 3 to 6 months of anticoagulation, but in cancer patients this period is extended if the cancer is still active.

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