The coagulation-inflammation axis in advanced cancer: associations with cardiovascular-thrombotic complications.

Cardiovascular–thrombotic complications (CVTCs) are common in advanced malignancies and contribute substantially to morbidity and mortality. The relationships between inflammation, coagulation abnormalities, and extracellular vesicle (EV) profiles in palliative-stage disease remain insufficiently understood. In this exploratory cross-sectional study, clinical characteristics, coagulation parameters, inflammatory markers, and EV profiles were assessed at a single time point in 80 patients with advanced solid tumors receiving palliative care. Patients with a history of CVTCs were compared with those without. Patients with CVTCs showed higher levels of IL-6 and CRP, prolonged coagulation times, and lower activities of several coagulation factors, including FII, FVII, FX, FXII, and FXIII. Fibrinogen and d-dimer levels were elevated in the overall cohort and were higher in patients with CVTCs. Exploratory regression analyses indicated associations between lower FII activity, higher platelet counts, older age, and the presence of CVTCs. Cancer patients exhibited higher concentrations of small EV–like particles and shorter EV-associated clotting times compared with healthy donors; however, EV-related measures did not differ between patients with and without CVTCs. Palliative cancer patients demonstrate heterogeneous alterations in inflammatory and coagulation parameters, with more pronounced abnormalities in those with CVTCs. EV concentrations were elevated overall but did not distinguish between clinical subgroups. These findings are descriptive and hypothesis-generating, underscoring the need for longitudinal studies to clarify temporal relationships, potential mechanistic pathways, and the clinical relevance of coagulation and EV-associated alterations in advanced cancer.