Venous thromboembolism (VTE) is common in
cancer patients, and is associated with significant morbidity and mortality. Several factors, including procoagulant agents secreted by
tumor cells, immobilization, surgery,
indwelling catheters, and systemic treatment (including
chemotherapy), contribute to an increased risk of VTE in
cancer patients. There is growing interest in instituting primary prophylaxis in high-risk patients to prevent incident (first-time) VTE events. The identification of patients at sufficiently high risk of VTE to warrant primary thromboprophylaxis is essential, as anticoagulation may be associated with a higher risk of
bleeding. Current guidelines recommend the use of pharmacological thromboprophylaxis in postoperative and hospitalized
cancer patients, as well as ambulatory
cancer patients receiving
thalidomide or
lenalidomide in combination with high-dose
dexamethasone or
chemotherapy, in the absence of
contraindications to anticoagulation. However, the majority of
cancer patients are ambulatory, and currently primary thromboprophylaxis is not recommended for these patients, even those considered at very high risk. In this concise review, the authors discuss risk stratification models that have been specifically developed to identify
cancer patients at high risk for VTE, and thus might be useful in future studies designed to determine the potential benefit of primary thromboprophylaxis.