Factors contributing to the hypercoagulable state and increased VTE risk in patients with cancer

	Contributing factor	Details
Tumor-associated	Tumor type	Highest risk with gastric and pancreatic cancer (2 points in the Khorana risk prediction model) Risk is also high with lung, lymphoma, gynecologic, bladder, and testicular cancer (1 point in the Khorana risk prediction model)
	Tumor stage and grade	Risk increases with more advanced cancer stage High-grade tumors may be associated with higher risk
	Timing since diagnosis	Risk increases 3 to 4 months prior to diagnosis and may return to baseline by 1 year after diagnosis
Patient-dependent	Age	Risk increases with increasing age
	Hereditary thrombophilia	Increased risk similar to patients without cancer
	Other VTE risk factors	Prior VTE (strongest risk factor) High body mass index Family history of VTE Acute illness
Therapy-related	Chemotherapy	Cisplatin Asparaginase
	Hormonal therapy	Tamoxifen Raloxifene
	Targeted and immunologic therapies	CDK inhibitors Antiangiogenic agents IMiDs Immune checkpoint inhibitors CAR-T therapy
	ESAs	Included in Khorana risk prediction model for VTE in cancer (1 point)
	Cancer surgery	Risk depends on type of surgery, as in patients without cancer
	Central catheter or port	Risk for catheter-associated upper extremity VTE

Risk is higher in the months immediately preceding diagnosis through the month following diagnosis. Refer to UpToDate for the magnitude of different risks.

VTE: venous thromboembolism; CDK: cyclin dependent kinase; IMiDs: immunomodulatory agents (thalidomide derivatives); CAR-T: chimeric antigen receptor T cells; ESA: erythropoiesis-stimulating agent.

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Factors contributing to the hypercoagulable state and increased VTE risk in patients with cancer