Lyman et al listed the risk factors for venous thromboembolism in a patient with a malignant disease. These can help identify a patient who may benefit from more aggressive management with prophylaxis. The authors are from multiple universities in North America in participation with the American Society of Clinical Oncology.


Risk factors associated with the patient:

(1) advanced age (will use > 65 years in the implementation)

(2) Afro-American

(3) past history of venous and/or arterial thromboembolism

(4) hereditary or acquired hypercoagulable state (Factor V Leiden, etc)

(5) thrombocytosis prior to chemotherapy

(6) obesity

(7) active infection

(8) comorbid organ dysfunction (renal, pulmonary, stroke, etc)



• The risk for thromboembolism is lower in Asians and Pacific Islanders.


Risk factors associated with the malignancy:

(1) presence of metastatic disease

(2) <= 6 months since initial cancer diagnosis

(3) site of the primary cancer: lung, gastrointestinal tract, brain, renal, leukemia, lymphoma, gynecologic


Risk factors associated with medications:

(1) current chemotherapy

(2) current hormonal therapy

(3) recent antiangiogenic therapy (thalidomide, lenalidomide, bevacizumab)

(4) current erythropoietin therapy


Risk factors associated with non-medication management:

(1) presence of a central intravascular catheter

(2) recent major surgery

(3) current hospitalization


Additional risk factors not listed:

(1) immobilization

(2) trauma with tissue necrosis (brain trauma, lung contusion, etc)

(3) tumor-related stasis (compression on veins, etc)

(4) peripheral vascular grafts


The greater the number of risk factors the greater the risk of venous thromboembolism.


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