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Patients with cancer are at an increased risk of developing blood clots, which are the second leading cause of death in cancer patients. This risk is particularly high at diagnosis and during active treatment of cancer, with well-known association with certain cancers and treatment modalities. The primary mission of the Cancer and Thrombosis Program at ICOS is to understand the pathogenesis of cancer associated thrombosis, identify patients at high risk for thrombosis and ultimately improve the outcomes for cancer patients with thrombosis. 

Research in cancer associated thrombosis has intensified in the past few years, raising awareness of this condition and issuance of guidelines for management and prevention of blood clots in cancer patients by major professional societies including National Comprehensive Cancer Center Network (NCCN), American Society of Clinical Oncology (ASCO) and American Society of Hematology (ASH). Patients with hematologic cancer constitute a unique group of cancer patients with increased risk of both thrombosis and bleeding complications. Severe thrombocytopenia and coagulopathy that is commonly seen in these patients presents a huge challenge for clinicians as well as investigators studying management of thrombosis in clinical trials. This has collectively resulted in exclusion of patients with hematologic cancer from majority of the studies developing risk models for blood clots and investigating safety and efficacy of newer anticoagulants. The aims of our program are to: 1) evaluate the risk factors for and 2) pathogenesis of cardiovascular disease (CVD) including venous thrombosis, stroke and coronary heart disease as well as 3) bleeding risk in patients with hematologic malignancies. By utilizing readily available datasets and development of our own registry of patients with leukemia, and establishing a biorepository of prospectively collected blood samples, we aim to understand the pathogenesis of these complications and identify novel biomarkers that can help in risk stratification to inform optimal management of thrombosis in hematologic malignancies. Though the risk of thrombosis is higher in the first 6 months after cancer diagnosis, we have shown that CVD risk remains high for several years after cancer diagnosis and we are interested in examining the long term risk of CVD in cancer survivors.

Another focus of our research is to understand the predictors of and racial disparities in clonal hematopoiesis of indeterminate potential (CHIP), which has emerged as a novel cardiovascular risk factor. CHIP refers to acquired somatic mutations in driver genes in hematopoietic stem cells that lead to clonal expansion of bone marrow and blood cells. Individuals with CHIP have a higher likelihood of developing low blood counts, hematologic malignancy, as well as atherosclerotic CVD and mortality. The goal of this study is to examine individual and environmental characteristics associated with CHIP, and how CHIP impacts CVD risk in cancer patients to decipher the link between cancer and CVD.