Thrombosis in Cancer: A Medical Professional's Guide to Cancer Associated Thrombosis

Pathophysiology and Risk Factors for CancerAssociated Thrombosis

Author(s): Fawzi Abu Rous*, Layan A. Elkhatib and Prajwal Dhakal

Pp: 7-26 (20)

DOI: 10.2174/9781681087849121010005

* (Excluding Mailing and Handling)

Abstract

Virchow’s triad of venous stasis, vascular damage, and blood hypercoagulability is the hallmark of VTE formation. Despite many studies done in recent times, the exact pathophysiology of cancer and VTE is still unknown. Various Tumor related, treatment-related and patient-related risk factors (RF) have been identified. Tissue-factor (TF), microparticles (MPs), inflammatory cytokines, and cancer procoagulants (CP) are some of the tumor-related risk factors. Tumor cellderived TNFa, IL-1b, and VEGF also contribute to cancer-induced hypercoagulability by other mechanisms, firstly they induce TF expression on monocytes. Several tumorrelated characteristics such as tumor site, type, stage (especially metastasis), histological variance and duration, are considered risk factors for the development of cancer-associated VTE. Surgery is the most important treatment-related risk factor in VTE in cancer patients along with other risk factors like hospital admission, chemotherapy, hormonal therapy, radiation therapy. patient-related factors such as age, gender, race, performance status, comorbidities, prior thrombosis, and prothrombotic mutations, are associated with an increased VTE risk in cancer patients. Several biomarkers have been investigated to quantitate and to predict the risk of VTE in cancer patients most important being D dimer, RF. Elevated levels of Ddimers are predictive of a higher risk of recurrent VTE in patients with cancer. Prechemotherapy platelet count has been shown associated with increased VTE risks in at least one study.


Keywords: Biomarkers of thrombosis in cancer, Cancer procoagulant, Coagulation cascade, D dimer in cancer, Hypercoagulability in cancer, Malignancy, Microparticles (MPs), Oncogene, Pathophysiology of thrombosis in cancer, Prechemotherapy platelet count, Risk factors for cancer thrombosis, Thrombosis in cancer, Tissue factor, Tumor suppressor gene, VEGF in cancer, Virchow’s Triad.

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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873362154 and j.to_ip >=873362154 )) and ((j.from_date <= 1739834668 and j.to_date >= 1739834668 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14919) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873362154 and j.to_ip >=873362154 )) and ((j.from_date <= 1739834668 and j.to_date >= 1739834668 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14919) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873362154 and j.to_ip >=873362154 )) and ((j.from_date <= 1739834668 and j.to_date >= 1739834668 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14919)
      720μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3072 and `b`.`banner_from_date` <= 1739834668 and `b`.`banner_to_date` >= 1739834668 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.03msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3072
      • 3: 1739834668
      • 4: 1739834668
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='92fc3ed3f5a4e310cf30ede3ab963ccd'
      190μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    16Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        hox9JqfqtU0vY3sjMAj5mnU7bXSwpWEdkSsDEcqf
        uc_cart_id
        92fc3ed3f5a4e310cf30ede3ab963ccd
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14919" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/14919
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:16 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Mon, 17 Feb 2025 23:24:28 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkRyZ2tGdHM1MFRCRVVGT09YaDM0d1E9PSIsInZhbHVlIjoiWk5JbGt2VUFQUVhsTk94QTVlVUMzSGI4eEZUYnBtUDBybDgrL1BFU3NESE5QUWpSOFV5WDhkaURTbEcwWnJkSk91WTEwSEIrbWNNRlE1SlRwd0g1TXE0WElEMXN6QVVCamVQY2ZtR3RWaHo1akVRWlB6YjVCd05XdEJPOEh6czkiLCJtYWMiOiI2YTk0ZDI3MzcxODE1N2U5OTg2NmY0MDhmMWI5ZDUwMjIwMDhmMzlhMzNjOGU4OTJjMzgzMzBkNzQyOGYzZWIxIiwidGFnIjoiIn0%3D; expires=Thu, 20 Feb 2025 11:24:28 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IkRyZ2tGdHM1MFRCRVVGT09YaDM0d1E9PSIsInZhbHVlIjoiWk5JbGt2VUFQUVhsTk94QTVlVUMzSGI4eEZUYnBtUDBybDgrL1BFU3NESE5QUWpSOFV5WDhkaURTbEcwWnJkSk91WTEwS" 1 => "alphaeurekaselectnet_session=eyJpdiI6Im14Q3puekhrWFVBSkVFNzJ6a25vR1E9PSIsInZhbHVlIjoiemFUUkJzSG9tVWlLc21nWFFYM3QrT1VkRno5LzNUeHF1cU93VUU1b2NpWU1jSDBybllSTHZ5Y1BRZXRlMEtob21qZ2dFcm5mR3E3U2ZTbTJwZndyOFJFQktpeEU4L0x3VnhjQ0p0aVBlSkh2Y1ExV3pQWk9Bc2xQeFdoM25USkwiLCJtYWMiOiI3MTIzN2VlMDFiNmFkM2FjMTk4YTA5Y2YyNDI3NjAxMGMxNThhMzM4Nzc0MWNmOWRmYTE4MzdiNWFkYmM1MGY0IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6Im14Q3puekhrWFVBSkVFNzJ6a25vR1E9PSIsInZhbHVlIjoiemFUUkJzSG9tVWlLc21nWFFYM3QrT1VkRno5LzNUeHF1cU93VUU1b2NpWU1jSDBybllSTHZ5Y1B" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkRyZ2tGdHM1MFRCRVVGT09YaDM0d1E9PSIsInZhbHVlIjoiWk5JbGt2VUFQUVhsTk94QTVlVUMzSGI4eEZUYnBtUDBybDgrL1BFU3NESE5QUWpSOFV5WDhkaURTbEcwWnJkSk91WTEwSEIrbWNNRlE1SlRwd0g1TXE0WElEMXN6QVVCamVQY2ZtR3RWaHo1akVRWlB6YjVCd05XdEJPOEh6czkiLCJtYWMiOiI2YTk0ZDI3MzcxODE1N2U5OTg2NmY0MDhmMWI5ZDUwMjIwMDhmMzlhMzNjOGU4OTJjMzgzMzBkNzQyOGYzZWIxIiwidGFnIjoiIn0%3D; expires=Thu, 20-Feb-2025 11:24:28 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IkRyZ2tGdHM1MFRCRVVGT09YaDM0d1E9PSIsInZhbHVlIjoiWk5JbGt2VUFQUVhsTk94QTVlVUMzSGI4eEZUYnBtUDBybDgrL1BFU3NESE5QUWpSOFV5WDhkaURTbEcwWnJkSk91WTEwS" 1 => "alphaeurekaselectnet_session=eyJpdiI6Im14Q3puekhrWFVBSkVFNzJ6a25vR1E9PSIsInZhbHVlIjoiemFUUkJzSG9tVWlLc21nWFFYM3QrT1VkRno5LzNUeHF1cU93VUU1b2NpWU1jSDBybllSTHZ5Y1BRZXRlMEtob21qZ2dFcm5mR3E3U2ZTbTJwZndyOFJFQktpeEU4L0x3VnhjQ0p0aVBlSkh2Y1ExV3pQWk9Bc2xQeFdoM25USkwiLCJtYWMiOiI3MTIzN2VlMDFiNmFkM2FjMTk4YTA5Y2YyNDI3NjAxMGMxNThhMzM4Nzc0MWNmOWRmYTE4MzdiNWFkYmM1MGY0IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6Im14Q3puekhrWFVBSkVFNzJ6a25vR1E9PSIsInZhbHVlIjoiemFUUkJzSG9tVWlLc21nWFFYM3QrT1VkRno5LzNUeHF1cU93VUU1b2NpWU1jSDBybllSTHZ5Y1B" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "hox9JqfqtU0vY3sjMAj5mnU7bXSwpWEdkSsDEcqf" "uc_cart_id" => "92fc3ed3f5a4e310cf30ede3ab963ccd" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14919" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:24:28GET/chapter/149191121918