Thromboembolic disease and hemostatic alterations in tumor-bearing dogs – A narrative review

Hemostatic dysfunction is a prevalent and significant complication in tumor-bearing dogs, driven by complex interactions between the tumor microenvironment and the host's coagulation system. This narrative review examines primary and secondary hemostatic alterations, fibrinolytic abnormalities, and prognostic indicators associated with hemostatic variables in canine lymphoma, carcinoma, and sarcoma. In lymphoma, the true prevalence of thromboembolic disease (TED) is unknown; clinically significant hemostatic alterations are typically associated with advanced stages, characterized by persistent hypercoagulability, or elevated D-dimer concentrations, and may be associated with a poor prognosis. Carcinomas are associated with TED, and hemostatic alterations are common, typically characterized by reactive thrombocytosis, hyperfibrinogenemia, and viscoelastic evidence of hypercoagulability. Sarcomas appear to be most associated with TED. Soft tissue sarcoma and osteosarcoma exhibit different hemostatic alterations and prognostic variables compared with hemangiosarcoma, and these differences are typically related to the stage of the disease. By synthesizing current evidence, recent advances, and key knowledge gaps, this review identifies the need to define tumor-specific hemostatic diagnostic profiles in tumor-bearing dogs and subsequently develop tailored thromboprophylaxis strategies. This may ultimately improve survival by enabling targeted management of hemostatic alterations and, potentially, by mitigating metastatic progression.