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Oncologists recognize that cancer patients are at increased risk for venous thromboembolism (VTE), yet they are reluctant to prescribe prophylactic anticoagulants because of concerns about bleeding. However, it might be possible to predict risk for VTE by examining specific patient and tumor characteristics. Now, investigators in Austria discuss a thrombosis-risk scoring system for cancer patients originally proposed by Khorana and colleagues (Blood 2008; 111:4902) and validated in several cohort studies.
In this risk-assessment model, numerical scores were assigned for several covariates, patients were stratified into one of three groups according to risk score, and VTE rate was determined for each group at 2.5 months of follow-up (see ).
Elevated D-dimer levels also predicted an increased risk for thrombosis. A variety of other hemostatic factors, as well as tissue-factor–bearing microparticles, were also informative.
Pabinger I et al. Biomarkers for prediction of venous thromboembolism in cancer. Blood 2013 Sep 19; 122:2011. (http://dx.doi.org/10.1182/blood-2013-04-460147)
Comment
Even though risk scores and biomarker measurements can identify cancer patients at increased risk for venous thromboembolism, confirmation that the benefits of anticoagulant prophylaxis outweigh the risks in such patients awaits the completion of placebo-controlled, randomized clinical trials. In the meantime, oncologists should calculate the thrombosis-risk score, assess bleeding risk, and use their clinical judgment in selecting the most appropriate intervention for each patient.