Risk assessment for recurrent venous thromboembolism in patients with cancer

Abstract

Cancer patients are at high risk for first and recurrent venous thromboembolism (VTE). While various risk factors for a first cancer-associated VTE event have been identified, information on risk factors for recurrent VTE is limited or inconsistent. Therefore, risk assessment for VTE recurrence in cancer patients is challenging at the moment.Certain patient- and tumor-related factors such as presence of metastasis and high VTE risk tumor types, such a pancreas and lung cancer, have been associated with an increased risk of recurrent VTE in patients with cancer. Previously, a risk assessment model, the Ottawa Score, was established to aid in the clinical decision-making regarding duration of anticoagulant therapy; however, its discriminative capacity could not be validated and therefore it is not implemented in clinical practice. There is an urgent call for meeting this medical need and providing tools for improved risk assessment and stratification for recurrent VTE in patients with cancer.In this review, we provide an overview of clinical as well as laboratory markers that influence the recurrence risk of cancer-associated VTE and critically appraise existing risk stratification tools and approaches of integrating risk assessment in clinical decision making.

Keywords

• Venous thromboembolism
• Cancer
• Recurrence
• Risk
• Anticoagulation