Commentary on 'microparticle-associated tissue factor activity in patients with metastatic pancreatic cancer and its effect on fibrin clot formation'

He died6 months later of gastric cancer.In the approximately 150 years since Trousseau’sobservation,muchhasbeenlearnedabouttheassociationof cancer, activation of the coagulation system, and clin-icalthrombosis.Yet,manyquestionsremain.Ifprocoagu-lant activity is expressed locally by the cancer cellsthemselves, why do thromboses typically develop atdistantsites?Deepveinthrombosesandresultantpulmo-naryembolismaremuchmorecommonthanlocalthrom-bosis at the cancer site. By what mechanism ormechanismsdocancercellsinduceasystemicprothrom-botic state? The new study by Thaler and colleagues, ontissue factor-bearing microparticles (TF-MP) helps toaddress this question. To understand the contribution ofthe Thaler article, it is helpful to first review the context.In addition to the observation that thrombosis ratesaremorecommonincancerpatients,anotherkeyobser-vation,mademynumerousauthors,isthatpatientswithlocally advanced or metastatic cancer who demonstratea thrombotic tendency exhibit a reduced survivalcompared with similar patients without a thrombotictendency. Sorensen et al