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Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and its complication, pulmonary embolism (PE), is a multifactorial disease, involving complex interactions between environmental exposures and patients, including their hemostatic system and genetic predispositions. VTE is relatively common, with an overall average ageand sex-adjusted incidence of about 1.04–1.9 per 1000 person-years that rises dramatically with increasing age [1–4]. Active malignancy accounts for almost 20% of incident VTE events occurring in the community [5], and imparts a 4to 6.5-fold higher VTE risk compared to non-cancer patients, depending on concurrent use of anti-cancer therapy [6]. The risk of VTE also varies by cancer type and stage [7–10]. The association between VTE and malignancy has been recognized since 1861 when Trousseau, in a lecture, described thrombophlebitis as the presenting sign of visceral malignancy [11]. In fact, idiopathic VTE may be a harbinger for an occult malignancy. Patients who present with an acute episode of idiopathic VTE have an approximately threeto fourfold increased likelihood of being diagnosed with a malignancy within a year of the VTE event [12–16], leading to a debate on whether cancer screening should be conducted in all individuals presenting with idiopathic VTE [17, 18]. While a clinical trial comparing extensive malignancy screening vs usual care for incident idiopathic VTE identified earlier stage malignancies in the extensive screening group and reduced the mean delay to cancer diagnosis from about 1 year to 1 month, 2-year cancerrelated mortality did not differ between the two groups [19], thus making it challenging to justify aggressive screening. VTE in cancer patients is associated with numerous negative implications, including significant morbidity and mortality. These patients may have their |
