Cancer-associated thrombosis Advances in diagnosis and treatment

Venous thromboembolism is an increasingly common complication in cancer patients and is associated with substantial morbidity and mortality. Despite appropriate anticoagulant therapy, the risk of recurrent venous thromboembolism is much higher in cancer patients than in those without cancer, as is the associated bleeding risk during treatment. While diagnostic algorithms for venous thromboembolism have improved over the years in patients without cancer, the performance of these strategies is still suboptimal in the cancer population. Further improvements are therefore needed in the diagnostic and therapeutic management of cancer-associated thrombosis. Part I of this thesis focuses on diagnostic approaches for venous thromboembolism in cancer and non-cancer patients, aiming at simple, patient-friendly, time-efficient, and safe methods to exclude venous thromboembolism while avoiding unnecessary diagnostic imaging. Part II aims at improving therapeutic strategies tailored to the individual cancer patient by considering not only efficacy and safety, but also route of administration and patient preference. Part III revolves around the inverse clinical association between cancer and thrombosis, and targets improvements in detection of undiagnosed cancer in patients presenting with unprovoked venous thromboembolism.