Adjuvant therapy and thrombosis: how to avoid the problem?

The occurrence of thrombosis complicates the management of breast cancer because of the need for anticoagulant therapy. The pathogenesis of venous thrombosis in breast cancer is related to Virchow's triad: venous stasis, hypercoagulability related to procoagulants and vessel wall injury secondary to chemotherapy and indwelling catheters. The rate of thrombosis with tamoxifen is approximately 0.9%. There does not appear to be an increased risk of venous thrombosis with aromatase inhibitors. The thrombotic rates in patients with early stage breast cancer receiving adjuvant chemotherapy range from 3% to 8%. Thrombotic rates are higher in post-menopausal women receiving adjuvant chemotherapy and in women receiving tamoxifen in combination with chemotherapy. Thrombosis can be reduced by avoiding chemotherapy in situations where its potential efficacy is marginal. In the future, new targeted agents may avoid thrombotic complications and a number of new antithrombotic agents which are oral and do not require laboratory monitoring could be used by oncologists to prevent thrombosis.