Twenty percent of venous thromboembolisms occur in patients with some form of cancer. The Division of Hematology and Hemostaseology of MedUni Vienna/Vienna General Hospital is one of the leading European centres in this field. A study group led by haemostaseology experts Ingrid Pabinger and Cihan Ay has been studying the relationships between cancer and thrombosis for 15 years. The group has now been invited to work with leading experts to draw up international guidelines to improve the care of cancer patients with an elevated thrombosis risk or in whom a thromboembolism has already occurred. These guidelines have now been published in the leading journal "Lancet Oncology".
Cancer patients have a much higher risk of developing venous thromboembolisms (e.g. leg vein thrombosis or pulmonary embolism). These complications are potentially life-threatening and are among the leading causes of death. There are many different causes for this but one particular feature is a change in blood composition. Tumours secrete substances that stimulate or activate blood clotting, thereby increasing the risk of thrombosis. Even cancer treatment itself can increase the tendency to develop blood clots.
The type of cancer also has a significant influence. For example, pancreatic cancer, brain tumours, stomach cancer, lung cancer, ovarian cancer, bowel cancer and leukaemia carry a significantly higher thrombosis risk. Cancer patients already have a higher general risk of developing thrombosis than the general population, and this is dependent upon the stage of the disease and the type of treatment.
Since 2003, the working group led by Pabinger and Ay at MedUni Vienna's Department of Medicine I has been conducting the CATS study (Vienna Cancer and Thrombosis Study), which has included more than 2,000 cancer patients. This study has already produced a lot of findings about the causes and risks of this frequent complication of venous thromboembolism in cancer.
The researchers have therefore been invited by the "International Initiative on Thrombosis and Cancer" to participate in drawing up new international guidelines. These guidelines have been checked by an international panel and endorsed by the International Society on Thrombosis and Haemostasis.
The fifth World Thrombosis Day will take on 13 October. To mark this occasion, the new guidelines – and in particular the thrombosis risk – will also be discussed at various events throughout the world. Cihan Ay explains: "New studies with direct oral anticoagulants, that is drugs to inhibit blood clotting, which are considered in these new guidelines, will improve and simplify the prevention and treatment of thrombosis in cancer patients."
2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Dominique Farge, Corinne Frere, Jean M. Connors, Cihan Ay, Alok A. Khorana, Andres Munoz, et. Al. DOI doi.org/10.1016/S1470-2045(19)30336-5