NPPB and metastatic neoplasm: To translate this into practice, we propose: (1) prophylactic anticoagulation for high-risk patients (e.g., metastatic disease or inherited thrombophilia), (2) serial echocardiography paired with biomarkers (troponin, BNP) during therapy, and (3) risk stratification models integrating thromboembolism history, PDA, and cancer type (e.g., Wilms tumor) to prioritize surveillance [31].