tissue factor expression angiogenesis and thrombosis in pancreatic cancer purpose hemostatic activation is common in pancreatic cancer and may be linked to angiogenesis and venous thromboembolism we investigated expression of tissue factor tf the prime initiator of coagulation in noninvasive and invasive pancreatic neoplasia we correlated tf expression with vascular endothelial growth factor vegf expression microvessel density and venous thromboembolism in resected pancreatic cancerexperimental design tissue cores from a triinstitutional retrospective series of patients were used to build tissue microarrays tf expression was graded semiquantitatively using immunohistochemistry in normal pancreas n10 intraductal papillary mucinous neoplasms n70 pancreatic intraepithelial neoplasia n40 and resected or metastatic pancreatic adenocarcinomas n130results tf expression was observed in a majority of noninvasive and invasive pancreatic neoplasia including 77 of pancreatic intraepithelial neoplasias 91 of intraductal papillary mucinous neoplasms and 89 of pancreatic cancers but not in normal pancreas sixtysix of 122 resected pancreatic cancers 54 were found to have high tf expression defined as grade or2 the median score carcinomas with high tf expression were more likely to also express vegf 80 versus 27 with low tf expression p00001 and had a higher median mvd 8 versus 5 per tissue core with low tf expression p001 pancreatic cancer patients with high tf expression had a venous thromboembolism rate of 263 compared with 45 in patients with low tf expression p004conclusions tf expression occurs early in pancreatic neoplastic transformation and is associated with vegf expression increased microvessel density and possibly clinical venous thromboembolism in pancreatic cancer prospective studies evaluating the role of tf in pancreatic cancer outcomes are warranted