Venous thromboembolism(VTE) is the leading cause of non cancer death in cancer patients. Patients are particularly at risk during chemotherapy where rates of up to 20% have been reported. Guidelines recommend primary prophylaxis with direct oral anticoagulants(DOACs) in intermediate/high risk patients undergoing chemotherapy following risk assessment with a validated risk score(Khorana score). However, the Khorana score performs poorly in lung, ovarian and gastric cancers and relies on a single assessment at the start of therapy.
The development of VTE is a dynamic process which cannot be accurately represented by a single risk assessment. Our data suggests that markers of procoagulant activity are implicated in chemotherapy associated VTE and could be measured serially as predictive biomarkers. This may provide a more effective method of identifying patients at risk of VTE and facilitate targeted prophylaxis.
Prophylaxis with DOACs carries a risk of bleeding hence decisions regarding prophylaxis should be shared between doctor and patient. However, studies have shown that cancer patients receive limited information about VTE risk and tools to aid decision making in this area are lacking. Cost is also a consideration for both the health service and the patient.
In this study we will:
measure procoagulant biomarker levels serially during chemotherapy as dynamic predictors of VTE.
investigate the prothrombotic mechanisms involved in chemotherapy associated VTE.
identify patient needs and priorities for shared decision making with regard to prophylaxis during chemotherapy
perform a cost benefit analysis of biomarker screening and targeted VTE prophylaxis during chemotherapy
This study aims is to develop dynamic predictive biomarkers for VTE during chemotherapy and to understand patient priorities with regard to VTE prevention during chemotherapy. Identification of high risk patients and increased understanding or patient priorities and costs will lead to effective shared decision between doctor and patient ultimately reducing the burden of VTE in cancer.