Venous thromboembolism in ovarian cancer: pathophysiology, risk, and management

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a common and potentially severe complication associated with ovarian cancer. This cancer, typically identified at a later stage, produces a hypercoagulable setting due to both inherent tumor characteristics and external treatment-induced influences. The interaction of pro-inflammatory cytokines, the expression of tissue factor (TF), activation of platelets, and mechanical obstruction of veins leads to a significant occurrence of thrombotic events. These occurrences not only deteriorate outcomes but also complicate treatment choices and elevate the strain on healthcare systems. Various risk factors lead to the increased VTE risk in ovarian cancer patients, such as significant tumor burden, cytoreductive surgery, chemotherapy, lack of mobility, and associated health issues like obesity or a history of thrombosis. The clinical signs of VTE may be subtle and nonspecific, necessitating a high level of clinical suspicion and careful application of imaging techniques for prompt diagnosis. Laboratory indicators like D-dimer and platelet count can provide helpful information but do not have specificity in patients with cancer. The recurrence rate of VTE in ovarian cancer is elevated, and its manifestation correlates with markedly lower overall survival. Management approaches emphasize prevention, prompt identification, and ongoing anticoagulant therapy. Low-molecular-weight heparins continue to be the standard treatment for numerous patients, while direct oral anticoagulants are becoming more popular because of their convenience and similar effectiveness. Thromboprophylaxis is especially important in the perioperative environment and throughout hospitalization.