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Q. What is VTE?

A. VTE is a collective term for both 'deep vein thrombosis' (DVT) and 'pulmonary embolism' (PE). VTE is a blood clot which forms inside a vein abnormally, blocking the vessels and reducing or preventing the blood flow. A part or all of the blood clot may come free and travel through the body, this can become very serious as it can cause a blockage in your heart or lungs.

Q. What are the Symptoms of VTE?

A. VTE can be difficult to diagnose, and can very easily be confused with less serious conditions. The most common symptoms are:

Sometimes there are no symptoms at all, which is why VTE is sometimes referred to as the ‘silent killer’.

Q. Why are cancer patients more at risk of developing VTE?

A. Cancer and its treatments are well recognised risk factors for VTE. Cancer promotes the development of VTE by inducing a hypercoaguable state. People with cancer often have a higher number of platelets and clotting factors in their blood. Platelets are blood cells that play a very important role in helping your blood to clot. They clump together to form a plug to stop bleeding. If you have more platelets than normal in your body, your blood is more likely to clot. Evidence suggests that the absolute risk depends on the tumour type, the stage or extent of the cancer and the treatment with anitneoplastic agents. Challenges of VTE management in cancer patients include heparin resistance because of excess circulating acute phase proteins, increased recurrence rates during warfarin therapy, limited venous access to support therapeutic monitoring, and increased bleeding rates during anticoagulation. Bleeding during anticoagulation is of particular concern in patients with disease or chemotherapy related thrombocytopenia, central nervous system involvement with cancer, and recent surgical intervention 7.  

Q. How many Cancer Patients are affected by VTE?

A. Numerous studies have tried to calculate the incidence of VTE in cancer patients, whilst there has been strong evidence showing the link between the two it has been notoriously difficult to quantitate the number of cancer patients who are affected. However it is preconceived that patients with Malignant disease are 7 times more likely to develop VTE 3. These cancer patients who develop VTE have a considerably higher chance of mortality, this was highlighted in the study by Lee 9 that during a 12 month period, 69% of cancer patients with solid tumours and acute VTE died. VTE is the second most common cause of death in cancer patients with VTE found at autopsy in at least 50% of patients 6.

Q. What is the treatment for VTE in cancer patients?

A. VTE is usually treated with drugs that help to thin the blood, called anticoagulants, these do not breakdown the clots but prevent them from increasing in size. The most common types of anticoagulants are:

The drug Heparin has anti-tumour effects in animal models of malignancy, and studies in human malignancy show improved cancer outcome with heparin treatment. Studies have shown that low-molecular-weight heparin (LMWH) has substantial improvement in cancer outcome.

Q. What are the survival rates?

A. Independently of the timing of cancer diagnosis, the life expectancy of cancer patients with VTE is relatively short. Patients with cancer and acute VTE who take anticoagulants for an extended period are at increased risk of recurrent VTE and bleeding 7. As previous mentioned LMWH provides a greater chance of prolonged survival. Although this is consistent across many clinical trials it is difficult to measure the survival rates as the exact incidence and time course of VTE among patients with different types and stages of cancer is largely unknown. A greater understanding of the incidence of VTE for each cancer type and stage would help define the subgroups of patients who might benefit the most, thus improving survival.

Patient relating Factors

  • Comorbid Conditions (Obesity, infection, renal disease, pulmonary disease, arterial thromboembolism)
  • Prior History of VTE
  • Elevated Pre-Chemotherapy Platelet Count
  • Heritable Prothrombotic Mutations

Cancer Associated Factors:

  • Primary site of Cancer (GI, Brain, Lung, Gynecologic, Renal, Hematologic)
  • Initial 3-6 months after diagnosis
  • Current metastric disease

Treatment related Factors:

  • Recent Major Surgery
  • Current Hospitalisation
  • Active Hormonal Therapy
  • Current or recent anitangiogenic therapy (thalidomide, lenalidomide, bevacizumab)
  • Current erythropoiesis-stilating agents
  • Presence of central venous catheters 8.
Mail: TRADAlliance@cardiff.ac.uk