Trousseau's syndrome: cancer-associated thrombosis

Trousseau's syndrome (cancer-associated thrombosis) is the second leading cause of death in can- cer patients, after death from cancer itself. The riskof avenousthromboembolism is 4- to 7-fold high- er in patients with cancer than in those without cancer. The causes of this impaired coagulation are associated with general patient-related risk factors, and other factorsthat are specific to the particular cancer or treatment. It is important to assess the risk of thrombotic events in cancer patients and ad- minister effective prophylaxis and treatment. Effective prophylaxis and treatment of venous thromboembolism reduces morbidity and mortality, and improves patients' quality of life. Low mo- lecular weight heparin is the first-line treatment for venous thromboembolism, as an effective and safe means for prophylaxis and treatment, according to guidelines released by international scien- tific societies. Oral anticoagulation therapy with warfarin is preferable to no therapy. However, war- farin has low efficacyand is associated with high rates of recurrence. If low molecular weight heparin is unavailable, some guidelines recommend the use of vitamin K antagonists that have a target inter- national normalized ratio in the range of 2-3, as acceptable alternatives. Novel oral anticoagulants that directly inhibit factor Xa or thrombin are promising for the prophylaxis of high-risk cancer pa- tients and in the long-term treatment of venous thromboembolism. However, to date, there is insuf- ficient evidence to support the use of these new anticoagulants.