Cancer-associated thrombosis Insights in epidemiology, treatment, prediction and prevention

Venous thromboembolism is a frequent complication in patients with cancer resulting in severe morbidity and mortality. Thromboembolic disease can also be the first sign of an occult malignancy. Despite years of research in this field, the cause of the relation between cancer and venous thromboembolism is not fully elucidated. Part I of this thesis focuses on screening for occult cancer in patients presenting with unprovoked venous thromboembolism. A recently introduced cancer screening test, based on RNA sequencing, is evaluated in a large cohort of patients with unprovoked venous thromboembolism. Part II provides up-to-date estimates of the incidence of venous and arterial thromboembolism in patients with cancer. In addition, the risk of cardiovascular diseases is explored in cancer survivors. Part III is aimed at treatment of venous thromboembolism in patients with cancer. The safety and efficacy of direct oral anticoagulants is compared to low molecular weight heparins in a systematic review and meta-analysis. The results imply that direct oral anticoagulants are an attractive treatment option. Part IV revolves around the prediction and prevention of cancer-associated venous thromboembolism. It shows that the use of genetic information of patients and of their tumor can strongly improve prediction of cancer-associated venous thromboembolism.