Cardiovascular disease risk factors and events are relatively common in PWH. PWH can be safely treated for CVD events with similar procedures as the non-PWH populations, though specific clotting factor prophylaxis protocols are not well defined.

Patients with cancer are at high risk to develop venous thromboembolism, and they are also more likely to develop complications from anticoagulant treatment. Because little research has focused on the oncology population to date, the optimal methods of prophylaxis and treatment remain uncertain in some clinical situations. Currently, low molecular weight heparin and warfarin are the most frequently used pharmacologic agents; however, they have their limitations. Other therapeutic options, such as inferior caval filters, are poorly studied and remain controversial. A summary of the most recent evidence on the prevention and treatment of venous thromboembolism in cancer patients is presented here.

This case illustrates the acute onset of life-threatening bleeding in a 57-year-old male with treatment-resistant metastatic prostate cancer. Laboratory results confirmed the presence of disseminated intravascular coagulation (DIC). Despite aggressive transfusion support, his consumptive coagulopathy and persistent bleeding could not be controlled, and his need for blood products began to outpace the available supply. Our patient had declined further chemotherapy treatment for his underlying aggressive prostate cancer and would accept only palliative care.Both thrombosis and bleeding are known to coexist during DIC. In our patient, his hemorrhagic clinical condition and laboratory results supported the presence of DIC with an excessive fibrinolytic process in the setting of metastatic prostate cancer. Following careful consideration of potential risks and benefits, the decision was made to administer the antifibrinolytic agent tranexamic acid to control bleeding. Initiation of this treatment led to rapid bleeding cessation without thrombotic complication. Although controversial, this treatment was life-saving in our patient and allowed hospital discharge. He remained transfusion independent for his remaining four weeks of life following discharge, and ultimately died at home of multi-organ failure related to his cancer.

No abstract