Cancer and thrombosis: from a 19th-century clinical phenomenon to the modern concept of tumor-associated coagulopathy

The article presents a historical and scientific review regarding the development of concepts about interplay between malignant neoplasms and thrombotic complications. The evolution of views on cancer-associated thrombosis is outlined: from the first clinical observations by J.-B. Bouillaud and the classic description by Armand Trousseau to the modern concept of tumor-associated coagulopathy and thrombotic risk stratification. The significance of the works carried out by R. Virchow and T. Billroth for the transition from clinical observations to a pathogenetic understanding of thrombosis as well as H. Dvorak’s contribution to form insights into tumor as a “wound that never heals,” pathological angiogenesis, vascular permeability, and the role for vascular endothelial growth factor are demonstrated. Special attention is paid to emergence of clinical hemostasiology, including the studies by M.-M. Samama, the International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC), and the contribution of the Russian Z.S. Barkagan and A.D. Makatsariya scientific schools to investigating hemostatic disorders, thrombophilia, and thrombosis in cancer patients. The final stage of this historical timeline is associated with the works by A. Khorana and the transition to formalized risk assessment of venous thromboembolic complications in patients with malignant neoplasms. Such analysis allows cancer-associated thrombosis to be envisioned not only as a vascular complication related to tumor process, but also as a genuine manifestation of the complex crosstalk between the tumor, the hemostatic system, the endothelium, inflammation, anticancer treatment, and individual patient risk factors.

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