Anticoagulation in the management of venous thromboembolism in the cancer patient

Abstract

Cancer is associated with a four to sevenfold increased risk of venous thromboembolism (VTE). This risk is influenced by the site and extent of cancer and its treatment. Despite its availability, effective VTE prophylaxis is used in less than 50% of oncology patients. Pharmacologic VTE prophylaxis should be administered to all hospitalized medical and surgical oncology patients for the duration of their hospitalization or up to 10-14 days, whichever is longer. Extended duration (up to 4 weeks post-operation) VTE prophylaxis is recommended for high-risk surgical oncology patients. Routine use of prophylaxis in ambulatory medical oncology patients awaits prospective testing of VTE risk assessment models. Routine prophylactic dose anticoagulation to prevent central venous catheter (CVC) thrombosis is ineffective and not indicated. Low molecular weight heparin is the first line choice for acute and chronic therapy of VTE in cancer patients. Therapy should continue for at least 3 months or the duration of the malignancy, whichever is longer. Anticoagulation is indicated for at least 3 months or the duration of the catheter for CVC thrombosis. Preliminary data indicate that some cancer patients with pulmonary embolism may be managed as outpatients. Prospective validation of these studies and testing of current risk assessment strategies in oncology patients is warranted. Management of recurrent VTE and unsuspected VTE in the cancer patient are also reviewed.

Pancreatic Carcinoma, Thrombosis and Mean Platelet Volume: Single Center Experience from the Southeast Region of Turkey

“…The risk of VTE is 4 to 6 times higher in patients with cancer (Heit et al, 2000;Streiff, 2011). Previous DVT, type of cancer, stage of cancer (localized vs. distant metastasis), time of diagnosis (greatest within the first 3 months), surgery, RT (pelvic radiation relative risk 2.0), and chemotherapy/biological therapy/antiangiogenesis/other agents are factors that affect the risk of VTE development (Adess et al, 2006).…”

Persistence of Hypercoagulable State after Resection of Intra-Abdominal Malignancies

“…41 In addition, it has been shown that although 82% of patients receive in-hospital thromboprophylaxis, only 31% receive it after discharge. 36,42 In our study, all patients received some sort of in-hospital thromboprophylaxis (sequential compression devices þ chemical thromboprophylaxis or sequential compression devices þ early aggressive ambulation for those admitted to the hospital floor), with the majority receiving the former. At this time, postdischarge extended thromboprophylaxis is not used routinely at our institution.…”

Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism

“…In our study, patients with continuous anticoagulation therapy were not eligible for study inclusion. The median time between a previous VTE event and study inclusion was 5 years (25th-75th percentile: [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. We recruited patients with newly diagnosed cancer and those with progressive disease after complete or partial remission.…”