Trousseau's syndrome: Concerns and controversies

The term "Trousseau's syndrome" describes cancer associated thrombosis, which is a major cause of morbidity and mortality in malignant disease. The underlying pathophysiology includes the production of procoagulant factors, release of inflammatory cytokines and direct interaction of cancer cells with the vascular endothelium and blood cells through adhesion molecules. The clinical spectrum is broad, ranging from pathological findings on laboratory tests and asymptomatic thrombosis to life threatening thromboembolic disease. The thrombogenic properties of tumor cells affect the prognosis and quality of life of patients, due to the high relapse rates of thrombosis and bleeding complications. The prognostic models of Trousseau's syndrome are based on the combined use of hypercoagulation indicators, and permit risk stratification and individualization of thromboprophylaxis. The low molecular weight heparins constitute the anticoagulant treatment of choice for both prophylaxis and treatment, and their immunomodulatory and antiangiogenic properties may affect the biological behavior of neoplastic disease. The role of novel oral anticoagulants in oncology is at present under investigation. This review summarizes current data on the pathophysiology of the disease, investigation of patients with idiopathic thrombosis, assessment of thromboembolic risk, therapeutic approach to incidental clotting events, the anticoagulant and antitumor properties of heparin and the role of novel oral anticoagulants in oncology.