Disorders of Thrombosis and Hemostasis in Cancer

Abstract

Cancer-associated thrombosis (CAT) remains a critical concern in hematology and oncology, contributing significantly to morbidity and mortality. The interplay between malignancy and hemostasis has been extensively studied, yet it continues to present clinical challenges and opportunities for advancement in prevention, treatment, and management. This special issue of Haemostaseologie—Progress in Haemostasis—Disorders of Thrombosis and Hemostasis in Cancer brings together seven review articles that explore diverse aspects of CAT, shedding light on current practices and emerging trends.

In collaboration with our valued colleague Nick van Es,[1] we worked on the topic of primary prevention of CAT. Our aim was to provide an update on thromboprophylaxis in medically ill patients undergoing systemic cancer therapy. We focused on the performance of risk assessment tools for CAT and provide support in identifying ambulatory patients with cancer at high risk of venous thromboembolism (VTE) who benefit most from medical thromboprophylaxis according to current recommendations from international guidelines.

Moreover, together with Christina Rolling,[2] we had the honor of addressing current treatment strategies for CAT in another review article. Based on recent data on the use of low-molecular-weight heparin and direct oral anticoagulants (DOACs) in cancer patients, we discuss efficacy and safety considerations while emphasizing the importance of personalized treatment based on patient-specific factors. Additionally, we provide a perspective on emerging approaches in the treatment of CAT such as factor XIa inhibitors.

Anticoagulation due to VTE can be a challenge in patients with malignancies as cancer patients are not only exposed to an increased risk of thrombosis but also have a high risk for bleeding complications. Demanding situations for the physician in the management of CAT include severe thrombocytopenia, recurrent thrombosis under therapeutic anticoagulation, and the question of optimal duration and intensity of anticoagulation. Ekaterina Balain [3] and co-authors present four cases of challenging situations in the treatment of CAT and provide guidance on individual management strategies.

CAT in pediatric populations requires unique considerations. Rahel Kasteler [4] and colleagues provide a detailed overview of CAT in pediatric patients, discussing the current state of knowledge and existing gaps. They not only explore emerging treatment options, such as the use of DOACs in pediatric cancer patients, but also examine distinct risk factors and primary prevention strategies.

In patients with thrombosis at unusual sites (“atypical” thrombosis, i.e., venous thrombosis affecting splanchnic veins or cerebral veins), rare causes need to be considered. Steffen Koschmieder and Jens Panse [5] give a comprehensive overview on the diagnostic approach and therapeutic management of myeloproliferative neoplasms (MPNs) and paroxysmal nocturnal hemoglobinuria (PNH). Besides anticoagulation, specific treatment in patients with MPN and PNH are necessary to reduce the risk of recurrence.

Immunotherapies, including immune checkpoint inhibitors, chimeric antigen receptor T cells and bispecific T cell engagers have revolutionized cancer therapy in recent years. The evolving interplay between these novel therapies and hemostasis is addressed in the review of Christina Rolling [6] et al. In detail, they explore the thrombotic and bleeding risks associated with these innovative treatments, examining the underlying mechanisms and offering strategies for monitoring and managing complications.

While extensive knowledge about the risk of thromboembolism and its management in patients with CAT has been generated in recent years, less is known about the bleeding risk. Cornelia Englisch [7] and colleagues took this as an opportunity and shed light on the recognition of the importance of bleeding risk in patients with cancer. The authors describe the clinical impact of bleeding events in patients with cancer, discuss the bleeding risk with and without anticoagulation and critically review risk assessment models for bleeding in cancer patients during anticoagulation.

We are honored to serve as guest editors for this special issue of Haemostasologie—Progress in Haemostasis and to contribute to the ongoing dialogue surrounding CAT. We extend our heartfelt thanks to the authors for their remarkable contributions and to the reviewers for their insightful feedback. We hope that this issue provides valuable perspectives and practical insights for clinicians, researchers, and health care professionals dedicated to improving outcomes for patients with cancer.

Conflict of Interest

The authors declare that they have no conflicts of interest.

• References

• 1 Hart C, van Es N, Voigtlaender M. Primary Prevention of Cancer-Associated Thrombosis: Current Perspectives. Hamostaseologie 2025; 45: 127-138
• 2 Voigtlaender M, Rolling C, Hart C. Treatment of Cancer-Associated Thrombosis: An Update. Hamostaseologie 2025; 45: 139-149
• 3 Balaian E, Marten S, Beyer-Westendorf J, Trautmann-Grill K. Challenging Situations in the Treatment of Cancer-Associated Thrombosis. Hamostaseologie 2025; 45: 150-157
• 4 Kasteler R, Albisetti M, Bosch A. Update on Cancer-Associated Venous Thromboembolism in Children. Hamostaseologie 2025; 45: 158-165
• 5 Koschmieder S, Panse J. Thrombosis at Unusual Sites: Focus on Myeloproliferative Neoplasms and Paroxysmal Nocturnal. Hemoglobinuria. Hamostaseologie 2025; 45: 166-174
• 6 Rolling CC, Lewirt S, Beitzen-Heineke A, Beckmann L, Bokemeyer C, Alsdorf W, Voigtlaender M, Langer F. Checkpoint Inhibitors, CAR T Cells, and the Hemostatic System: What Do We Know So Far?. Hamostaseologie 2025; 45: 175-187
• 7 Englisch C, Vladic N, Ay C. Bleeding Risk in Patients with Cancer. Hamostaseologie 2025; 45: 188-203

Publication History

Article published online:
07 May 2025