Thromboembolism complications in tumor diseases: pathophysiology, risk factors and preventive approaches

Thromboembolic complications are among the most common causes of death in cancer patients and result in considerable reduction in quality of life in patients affected. Besides immobilization therapeutical interventions such as surgery, chemotherapy and insertion of an indwelling central venous line have been identified as additional risk factors for thromboembolism. While postoperative prophylaxis is recommended, anticoagulation in presence of other risk factors, especially concerning cost-benefit ratio, is still a matter of debate. Evaluation of genetic risk factors for thromboembolism may add in the near future to the decision-making process to provide cancer patients with antithrombotic prophylaxis. With the introduction of low molecular weight heparin to clinical practice clinicians now face an alternative option to oral anticoagulants for long-term therapy and prophylaxis. Suggestive evidence that low molecular weight heparin reduce mortality of cancer patients independent of cardiovascular causes have stimulated intensive clinical efforts to reinvestigate anticoagulation in cancer patients.