Blom et al identified risk factors for venous thrombosis in a patient with a malignancy. These can help identify a patient who may require anticoagulation and closer monitoring. The authors are from Leiden University in Leiden, the Netherlands.


Parameters associated with risk of venous thrombosis:

(1) type of malignancies

(2) time since initial diagnosis of the malignancy

(3) metastases

(4) hereditary prothrombotic mutations


Types of malignancy with a high risk of venous thrombosis:

(1) hematologic malignancy (non-Hodgkin's lymphoma, Hodgkin's disease, leukemia, multiple myeloma)

(2) lung cancer

(3) gastrointestinal cancer (bowel, stomach, pancreas, esophagus)


Other types of malignancy associated with increased risk of venous thrombosis include:

(4) kidney

(5) female breast

(6) brain


A few patients may have two or more types of cancer associated with a risk of venous thrombosis.


The risk for venous thrombosis is highest in the first 3 months after initial diagnosis. It remains high in the interval from 3 to 12 months after diagnosis. It gradually declines over time, but this may reflect the effect of patient's dying.


The presence of distant metastases greatly increases the risk of venous thrombosis.


Hereditary prothrombotic mutations which may worsen the risk for venous thrombosis in a patient with a malignant tumor:

(1) Factor V Leiden

(2) prothrombin G20210A


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