Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2021; 27(19): 2325-2340
Published online May 21, 2021. doi: 10.3748/wjg.v27.i19.2325
Burden of venous thromboembolism in patients with pancreatic cancer
Corinne Frere
Corinne Frere, Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris F-75013, France
Corinne Frere, INSERM UMRS_1166, Institute of Cardiometabolism And Nutrition, GRC 27 GRECO, Sorbonne Université, Paris F-75013, France
Corinne Frere, Groupe Francophone Thrombose et Cancer, Saint-Louis Hospital, Paris F-75010, France
Author contributions: Frere C performed the literature review and drafted the manuscript.
Conflict-of-interest statement: The author declare she has no conflict of interest relevant to the content of this paper to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Corinne Frere, MD, PhD, Assistant Professor, Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, Paris F-75013, France.
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: February 22, 2021
Revised: February 28, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 21, 2021

Pancreatic cancer (PC) is a devastating malignancy with fewer than 10% of patients being alive at 5 years after diagnosis. Venous thromboembolism (VTE) occurs in approximatively 20% of patients with PC, resulting in increased morbidity, mortality and significant health care costs. The management of VTE is particularly challenging in these frail patients. Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges. The International Initiative on Thrombosis and Cancer multi-language web-based mobile application (downloadable for free at has been developed to help clinicians in decision making in the most complex situations. In this narrative review, we will discuss the contemporary epidemiology and burden of VTE in PC patients, the performances and limitations of current risk assessment models to predict the risk of VTE, as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support up-dated clinical practice guidelines.

Keywords: Pancreatic cancer, Venous thromboembolism, Low-molecular weight heparin, Direct oral anticoagulant, Multi-language mobile application, Risk-assessment models, Thromboprophylaxis

Core Tip: Venous thromboembolism (VTE) is a common but potentially life-threatening complication in patients with Pancreatic cancer (PC). There is an urgent need to raise awareness on this underrecognized issue. This review discusses the incidence and risk factors of VTE in PC patients, and the results from recent clinical trials for the primary prophylaxis and treatment of VTE in cancer patients supporting the most recent clinical practice guidelines.