The pivotal role of thrombin in cancer biology and tumorigenesis.

The association of cancer and thrombosis has been known for nearly 150 years. Compared with patients without cancer, those with cancer have an increased risk of thrombosis and recurrent thrombosis. It is now well accepted that patients with idiopathic venous thromboembolism are also at increased risk of later being diagnosed with cancer. This is further confirmation of the intertwined nature of cancer and thrombosis. Although the mechanisms of this association are still under examination, much work has accrued over the past two decades to suggest an influence of thrombin on cancer biology. This review focuses on the important role of thrombin in cancer research; recent in vitro work illustrating the mechanisms by which thrombin may affect cancer angiogenesis, cell invasion, and enhanced tumor metastasis; and on clinical trials investigating the potential role of antithrombotics in cancer incidence and survival.