Tesselaar and Osanto identified a number of factors associated with an increased risk of thromboembolism in a patient with primary lung cancer. These can help identify a patient at increased risk for this potentially fatal complication. The authors are from Leiden University in The Netherlands.


Risk factors for venous thromboembolism:

(1) adenocarcinoma

(2) distant metastases

(3) pneumonectomy, lobectomy or other surgery

(4) chemotherapy

(5) therapy with antiangiogenic drugs (thalidomide, other)

(6) anti-VEGF (vascular endothelial growth factor) targeted drugs

(7) an elevated pretreatment platelet count

(8) erythropoietin therapy



• If erythropoietin therapy is a risk factor for thromboembolism, then polycythemia secondary to COPD may also be a risk factor.

• The authors also list increased circulating tissue thromboplastin as a risk factor, but since this is not routinely measured it is not included in the implementation.

• Brain metastases would be expected to generate tissue thromboplastin.

• The PT and PTT do not correlate with the risk of thrombosis.

• A patient may develop thrombosis after surgery despite prophylactic therapy.

• A person with multiple risk factors should take precautions on long airplane flights.


Additional risk factors not listed in the paper:

(1) pre-existing hypercoagulable disorder

(2) prolonged immobility


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