Special Cases in Cancer-Associated Thrombosis

Thrombosis and thrombocytopenia are common in malignancy due to microangiopathic disorders (thrombocytopenic purpura, immune disorder, immune thrombocytopenic purpura, and heparin-induced thrombocytopenia), chemotherapy side effect, or direct cancer effect. Recurrent VTE (while on anticoagulation) is also common, risk factors include metastasis, young age, and short interval between cancer diagnosis and VTE. VTE remains a major challenge among those with renal impairment. Incidental VTE is an unexpected thrombosis detected in a patient undergoing imaging study for other indications. Incidental VTE has been attributed to malignancy or chemotherapy side effects. Philadelphia chromosome-negative Myeloproliferative Disorders (Polycythemia Vera (PV), Essential thrombocytosis (ET), and Primary Myelofibrosis (PMF) has been implicated with high risk for both venous and arterial thromboembolism. Venous thromboembolism (VTE) has been increasingly associated with hematological malignancy as well.