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Semin Thromb Hemost 2021; 47(08): 942-949
DOI: 10.1055/s-0041-1733927
Review Article

Arterial Thrombosis in Cancer Patients: An Update

Massimo Franchini
1   Department of Haematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
,
Antonella Tufano
2   Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
,
Aniello Casoria
2   Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
,
Antonio Coppola
3   Department of General and Specialist Medicine, Hub Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
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Abstract

Cancer is associated with an increased incidence of both venous thromboembolism (VTE) and arterial thrombosis (cardiovascular events and ischemic stroke). Cancer-associated arterial thrombotic events are less well studied than VTE, but increasingly recognized, particularly in specific malignancies and in association with specific anticancer therapies. The pathogenesis of arterial thrombotic events in cancer is complex and involves generation of tumor-associated procoagulant factors and a variety of alterations in platelet function as well as in the coagulation and fibrinolytic systems, and endothelial injury and dysfunction, that combine to produce hypercoagulability. The multifactorial interaction between this prothrombotic state, the individual cardiovascular risk, advanced age and presence of comorbidities, and the specific neoplasm characteristics and therapy, may induce the vascular events. Recent studies based on population databases and prospective or retrospective analyses with prolonged follow-up highlight that cancer patients experience an increased (approximately 1.5–2-fold) risk of both cerebrovascular and cardiovascular events compared with noncancer individuals, which peaks in the time period of the diagnosis of cancer but may persist for years. Beyond the type of cancer, the risk reflects the tumor burden, being higher in advanced stages and metastatic cancers. The occurrence of arterial thromboembolic events is also associated with increased overall mortality. We here present an update of the pathophysiology, risk factors, clinical evidence, and treatment considerations on cancer-associated arterial thrombosis, in the light of the need for specific multidisciplinary prevention and surveillance strategies in this setting, in the frame of cardio-oncology approaches.

Keywords

arterial thrombosis - cancer - myocardial infarction - stroke - thromboembolism


Publication History

Article published online:
31 August 2021

© 2021. Thieme. All rights reserved.

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