Clinical roundtable monograph. The oncologist's role in management of venous thromboembolism.

Thromboembolism is the second leading cause of death in cancer patients. Patients with venous thromboembolism (VTE) and malignancy have a significantly higher probability of death. Pulmonary embolism can lead to a fatal outcome, and this condition often goes undiagnosed in cancer patients despite the presence of symptoms. Risk of VTE is increased by a number of clinical factors, which can be patient-derived, cancer-related, and treatment-related. Increasingly, clinicians are seeking predictable biomarkers to identify those patients at the greatest risk. To that end, a newly developed and validated predictive risk model may help identify patients who could benefit from prophylaxis. In addition, serum levels of coagulation cascade factors may predict the survival rate of cancer patients; elevated D-dimer levels are associated with decreased survival time. Anticoagulants, particularly low-molecular-weight heparin, can be useful in preventing the recurrence of clots in cancer patients with VTE. Current and future investigations are aimed at determining if prophylaxis with anticoagulants can improve patient survival. Future management strategies may involve the use of low-molecular-weight heparin or other novel anticoagulants as part of palliative care for high-risk patients. Although treatment with low-molecular-weight heparin can significantly reduce the risks of clots, the impact on cancer survival is unclear.