Unconventional approaches to the prevention of cancer associated thrombosis.

A number of strategies are currently under investigation to prevent venous thromboembolic events in cancer cohorts. Based on the efficacy of low molecular weight heparin in the treatment of thrombosis in cancer patients, a number of clinical studies have focused on evaluating the efficacy the low molecular weight heparins in the primary thromboprophylaxis setting. Further refinements in defining which cancer cohorts are at greatest risk of suffering thromboembolic events are under investigation such as clinical-laboratory risk scores and biomarkers such as tissue factor-bearing microparticles. However, alternative approaches to primary thromboprophylaxis beyond standard anticoagulants are also being evaluated in the clinic such anti-platelet agents, statins to reduce circulating tissue factor, and scheduled monitoring for venous thromboembolic events without pharmacologic thromboprophylaxis. In addition, clinical studies are underway to evaluate the antithrombotic efficacy of targeting extracellular protein disulfide isomerase with oral flavonoids (e.g. quercetin and isoquercetin). Emerging data regarding these unconventional approaches in the prevention of thromboembolic events in cancer patients is reviewed.