Published: 2017-05-27

Thrombocytosis as a predictor of thromboembolic complications in patients with malignant diseases

Branislava Jakovljević, Siniša Maksimović, Aleksandar Jakovljević, Darko Jović, Ljiljana Latinović, Jovan Ćulum, Nebojša Trkulja, Sanja Sibinčić, Amir Spahic


Background: To prove the frequency of thrombocytosis in patients with cancer, and the importance of anticoagulant therapy. Thrombocytosis represents an elevated platelet count of more than 350,000/mm3 which is one of the risk factors for venous thromboembolism.

Methods: This study has analyzed 146 patients who were hospitalized at the Oncology Clinic of the University Clinical Centre, Banja Luka and the Day Oncology Hospital “S.tetik”, Banja Luka in the period between 2009 and 2014. These were patients with breast tumor, gastrointestinal or gynecological malignancies. Thrombocytosis was detected in 38 patients in the moment of diagnosing. All examinees were analyzed by sex, age, primary site of tumor, presence of comorbidity, relevant laboratory analyses, clinical stage of the disease (metastatic or localized disease).

Results: In the observed sample of 146 patients, thrombocytosis was detected in 38 patients in the moment of diagnosing the disease (26%). Through the follow-up, DVT (deep venous thrombosis) was found in 13 patients (34.2%) and anticoagulant therapy was administered. Out of patients who were not on anticoagulant therapy because they had no thrombotic manifestations (25 patients, 65.8%), 2 ended up experiencing the development of a clinical presentation of massive pulmonary embolism with fatal outcome.

Conclusions: The occurrence of thromboembolism significantly increases morbidity and mortality, as well as the total cost of treating cancer patients. Regardless of the fact that cancer patients are at a high risk of thromboembolic events, thromboembolic prophylaxis has not been adopted as a standard therapeutic modality because of potential bleeding.


Neoplasms, Risk factors, Thromboembolism

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Stone RL, Nick AM, McNeish IA, Balkwill F, Han HD, Bottsford-Miller J, et al. Paraneoplastic thrombocytosis in ovarian cancer. N Engl J Med. 2012;366:610-8.

Trousseau A, Bazire V, Cormack J. Lectures on clinical medicine, delivered at the Hôtel-Dieu, Paris. London: R. Hardwicke; 1867.

Kumar V, Abul KA, Fausto N, Mitchell R. Robbins Basic Pathology, 8ed. Elsevier Inc. New York, NY USA; 2007.

Borsig L. The role of platelet activation in tumor metastasis. Expert Rev Anticancer Ther. 2008;8:1247-55.

Bick RL. Cancer-associated thrombosis. New Engl J Med. 2003;349:109-11.

Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902-7.

Ay C, Dunkler D, Marosi C. Prediction of venous thromboembolism in cancer patients. Blood. 2010;116(24):5377-82.

Ay C, Pabinger I. Tests predictive of thrombosis in cancer. Thromb Res. 2010;125(2):S12-5.

Khorana AA, Francis CW, Blumberg N, Culakova E, Refaai MA, Lyman GH. Blood transfusions, thrombosis, and mortality in hospitalised patients with cancer. Arch Intern Med. 2008;168(21):2377-81.

Khorana AA, Dalal MR, Lin J, Connolly GC. Health care costs associated with venous thromboembolism in selected high-risk ambulatory patients with solid tumors undergoing chemotherapy in the United States. Clinicoecon Outcomes Res. 2013;5:101-8.

Degen JL, Palumbo JS. Hemostatic factors, innate immunity and malignancy. Thromb Res. 2012;129(1):S1-5.

Marshall AL, Campigotto F, Neuberg D. Recurrence of venous thromboembolism in patients with cancer treated with warfarin. Clin Appl Thromb Hemost. 2015;21:632-8.

Chai-Adisaksopha C, Iorio A, Crowther MA. Cancer-associated thrombosis. 2015 ASH Annual Meeting. Abstract 430.

Khorana AA, McCrae K, Milentijevic D. Current practice patterns and patient persistence on anticoagulant treatments for cancer-associated thrombosis. 2015 ASH Annual Meeting. Abstract 626.

Hanan J, Elkacemi H, Bensaid B, Afif M, Bensaid Y, Kebdani T, et al. Venous thromboembolism in cancer patients: an underestimated major health problem, World J Surg Oncol. 2015;13:204.

Chew HK, Davies AM, Wun T, Harvey D, Zhou H, White RH. The incidence of venous thromboembolism among patients with primary lung cancer. J Thromb Haemost. 2008;6(4):601-8.

Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patients with cancer. J Clin Oncol. 2009;27(29):4839-47.

Stein PD, Beemath A, Meyers FA, Skaf E, Sanchez J, Olson RE. Incidence of venous thromboembolism in patients hospitalized with cancer. Am J Med. 2006;119(1):60-8.

Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States. Cancer. 2013;119(3):648-55.

Pritchard KI, Paterson AH, Paul NA, Zee B, Fine S, Pater J. Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer. National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group. J Clin Oncol. 1996;14(10):2731-7.

Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715-22.

Agnelli G, George DJ, Kakkar AK. SAVE-ONCO Investigators. Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med. 2012;366(7):601-9.

Agnelli G, Gussoni G,Bianchini C. PROTECHT Investigators. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study. Lancet Oncol. 2009;10(10):943-9.

Streiff MB. National Comprehensive Cancer Center Network. The National Comprehensive Cancer Center Network (NCCN) guidelines on the management of venous thromboembolism in cancer patients. Thromb Res. 2010;125(2):S128-33.

Farge D, Debourdeau P, Beckers M. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost. 2013;11(1):56-70.

Debourdeau P, Farge D, Beckers M. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost. 2013;11(1):71-80.

Lyman GH, Khorana AA, Kuderer NM. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guidelines update. J Clin Oncol. 2013;31(17):2189-204.

Mandala M, Falanga A, Roila F. ESMO Guidelines Working Group, Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2011;22(6):vi85-92.