Thrombotic Pathogenesis and Laboratory Diagnosis in Cancer Patients, An Update

Figures & data

Figure 1 Schematic representation of the direct mechanisms for cancer-associated thrombosis.

Figure 2 Schematic representation of the indirect mechanisms for cancer-associated thrombosis.

Table 1 Biomarkers Currently in Use for Venous Thromboembolism Risk Assessments in Cancer Patients

Biomarker	Pathophysiological Significance	Biomarker Patterns in VTE
Tissue factor	Initiates secondary hemostasis upon injury to a vessel, and forms complexes with other procoagulants to enhance clotting	Increased levels
D-dimer	Protein fragment formed from fibrin degradation due to active coagulation	Increased levels
Soluble P-selectin	Reflects the degree of platelets activation and thrombosis	Increased levels
Thrombin generation test	Checks the overall concentration of thrombin being generated	Increased levels
Thrombin-anti-thrombin complexes	A biological defense reaction inhibiting thrombin formation due to thrombosis	Increased levels
Platelet factor 4	Promotes blood coagulation upon release by activated platelets	Increased levels
Molecular and cytogenetic testing	Identification of pathogenic mutations in genes encoding corresponding clotting factors	Factor V Leiden, G20210A prothrombin gene, Factor X.

Table 2 Novel Biomarkers Still under Investigation for Venous Thromboembolism Risk Assessments in Cancer Patients

Biomarker	Pathophysiological Significance	Biomarker Patterns in VTE
Microparticles	Provides the platform for fibrin clotting, and enhancement of other plasma proteins	Increased levels
Prothrombin fragment 1+2	By-product of prothrombin conversion to thrombin	Increased levels
CD40 Ligand	Reflects the degree of prothrombotic responses	Increased levels
Thrombospondin-1	Enhances platelet aggregation	Increased levels
Molecular and cytogenetic testing	Identification of pathogenic mutations in genes encoding corresponding clotting factors	STK11, KRAS, CTNNB1, KEAP1, CDKN2B, MET, EPCR, and FGG rs2066865.