Semin Thromb Hemost 2021; 47(08): 914-919
DOI: 10.1055/s-0040-1718927
Review Article

Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: Risk Factors and Prevention

Paolo Prandoni
1  Arianna Foundation on Anticoagulation, Bologna, Italy
Elena Campello
2  Department of Medicine, University Hospital of Padova, Padova, Italy
› Author Affiliations
Funding None.


Ambulatory cancer patients undergoing chemotherapy are at a substantial risk for venous thromboembolism (VTE) over the course of therapy and beyond it. Factors accounting for this risk include the activation of extrinsic and intrinsic coagulation pathways, platelet activation, impaired fibrinolysis, use of catheters, infusion of blood products, and thrombogenic potential of several chemotherapeutic drugs. A few stratification models can help identify patients at a higher risk of chemotherapy-associated VTE, who may benefit from preventive strategies. Although low-molecular-weight heparins (LMWHs) effectively reduce the risk of VTE, current guidelines recommend against their routine use. Based on the results of recent randomized controlled clinical trials, the administration of prophylactic doses of the novel direct oral anticoagulants (DOACs) to ambulatory cancer patients undergoing chemotherapy has the potential to offer an effective and safe protection against VTE, obviating the inconveniences of heparins. Except for patients in whom the novel drugs are unsuitable or are contraindicated, in all other patients LMWHs should be replaced by low-dose DOACs.


This was a spontaneous, unfunded, unsponsored study. The corresponding author had full access to all the data in the study and takes the final responsibility for the decision to submit the manuscript for publication.

Publication History

Publication Date:
22 January 2021 (online)

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