Predictive potential of haemostatic biomarkers for venous thromboembolism in cancer patients.

Venous thromboembolism (VTE) is a common problem in cancer patients. However, the rates of VTE vary widely between different types of malignancies. Furthermore, patient- and treatment-related risk factors contribute to the risk of VTE. The prediction of the individual risk of VTE and the identification of patients with cancer that might benefit from thromboprophylaxis is a major clinical challenge, because the pathogenesis of cancer-associated VTE is multifactorial. Therefore, recent studies have focused on identification of predictive biomarkers for VTE. As there is a close interrelation between cancer and the haemostatic system, which leads to activation of haemostasis and fibrinolysis, biomarkers of the haemostatic system seem to be promising in predicting risk of developing VTE in cancer patients. Some candidate biomarkers or laboratory tests of the haemostatic system including platelet count, soluble P-selectin, tissue factor (TF) and TF-bearing microparticles, coagulation factor VIII, D-dimer, prothrombin fragment 1+2 and the thrombin generation assay have been reported to predict cancer-associated VTE. In addition, it has been shown that risk-scoring models, incorporating clinical parameters and biomarkers, allow risk stratification of cancer patients into groups at high- and at low risk of VTE. The accuracy of a previously established risk scoring model can be improved when it is expanded and biomarkers of the haemostatic system are added. The benefit of a targeted thromboprophylaxis for primary prevention of VTE in cancer patients based on risk assessment by measuring biomarkers or applying risk scoring models has to be shown in interventional clinical trials.