Role of four new blood coagulation tests in cancer stem cell-mediated tumor-related venous thromboembolism

Abstract

Patients with cancer often have a marked hypercoagulable state, which significantly raises the risk of thrombosis. Recent studies have shown that cancer stem cells (CSCs) play a crucial role in creating this prothrombotic environment by influencing the coagulation cascade and triggering thromboinflammation. This review comprehensively examines the role of four novel blood coagulation tests – thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2-antiplasmin complex (PIC), and tissue-type plasminogen activator-inhibitor 1 complex (t-PAIC) – in the context of cancer stem cell-mediated tumor-related venous thromboembolism (VTE). These markers offer distinct advantages over traditional coagulation assays for dynamic monitoring of coagulation and fibrinolysis in cancer-associated VTE, providing a more nuanced assessment of patient status. We elucidate the predictive, diagnostic, and risk-assessment value of this “four-item test,” exploring its potential to identify patients at high risk of VTE and to monitor treatment efficacy. Furthermore, we delve into the underlying pathophysiological links connecting CSC activity, cancer-associated thrombosis (CAT), thromboinflammation, and the formation of neutrophil extracellular traps (NETs), suggesting that these biomarkers may offer valuable insights into the mechanisms driving thrombosis in cancer.

Keywords: Cancer-associated thrombosis, Cancer stem cells, Neutrophil extracellular traps, Thrombomodulin, Thrombin-antithrombin complex, Venous thromboembolism