Venous Thromboembolism (VTE) is a potentially devastating and yet frequently under-recognised complication of active cancer and cancer therapy. The risk of VTE is thought to be at least 5-fold higher among patients receiving cancer therapy than that which is observed in the general population and it is estimated that up to 20% of all patients with cancer will experience some form of venous thrombosis during the course of their disease. 1-3 Acute VTE among patients with cancer is associated with a particularly high burden of morbidity and mortality risk. Cancer patients who develop VTE have a risk of recurrent thrombosis (despite optimal anticoagulant therapy) which may be as high as 20% at 12 months. 4, 5 Patients with cancer also experience more anticoagulant-related bleeding events than that observed in the general population. 5 The risk of death following VTE recurrence is also substantially higher among patients with cancer, estimated to be in the region of 15% in some subgroups. 6 In fact it is widely recognised that VTE represents the second-leading cause of death among patients with cancer, second only to the progression of cancer itself. 7 While significant advances have been made in recent years, several important clinical questions have yet to be addressed. The development of strategies for individualised prediction of VTE risk has proven to be challenging. Consequently, there is a degree of uncertainty among clinicians regarding the optimal approach to the use of primary pharmacological thromboprophylaxis for potentially ‘high-risk’ patients. Similarly, it remains to be determined if novel drug targets may represent a means of addressing the high rates of VTE recurrence and bleeding which continue to arise in this patient population despite current best therapy.
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