Treatment of cancer-associated thrombosis

Abstract

Therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer remain very limited. Although low-molecular-weight heparin monotherapy has been identified as a simple and efficacious regimen compared with an initial parenteral anticoagulant followed by long-term therapy with a vitamin K antagonist, many clinical questions remain unanswered. These include optimal duration of anticoagulant therapy, treatment of recurrent VTE, and the treatment of patients with concurrent bleeding or those with a high risk of bleeding. Treatment recommendations from consensus clinical guidelines are largely based on retrospective reports or extrapolated data from the noncancer population with VTE, as randomized controlled trials focused on cancer-associated thrombosis are sorely lacking. Furthermore, with improvements in imaging technology and extended survival duration of patients with cancer, we are encountering more unique challenges, such as the management of incidental VTE. Clinicians should be aware of the limitations of the novel oral anticoagulants and avoid the use of these agents because of the paucity of evidence in the treatment of cancer-associated thrombosis.

Deep Vein Thrombosis Interventions in Cancer Patients

“…19 In cancer patients treated with IVC filters, recurrence rates of VTE have been reported as high as 32%. 22 Given this increased risk of recurrent DVT, IVC filters should be used judiciously in the cancer population, with placement of a retrievable IVC filter for patients who have a significant likelihood of becoming candidates for anticoagulation.…”

“…18 Thus, there is no strong evidence to routinely exclude these patients. 19 However, discriminate patient selection remains important. Patients who are most likely to benefit from CDT include those with iliofemoral DVT, symptoms for less than 14 days, good functional status, a life expectancy over 1 year, and a low risk of bleeding.…”

Portal vein thrombosis in a patient with a malignant rhabdoid tumor of the liver (Case report)

“…В настоящее время при формировании ВТ, непо-средственно не угрожающего жизни, стандартом терапии является применение НФГ или НМГ. В случае возник-новения ВТ, непосредственно угрожающего жизни пациента или потерей ткани, органа, возможно прове-дение системного и локального тромболизиса (реком-бинантный тканевой активатор плазминогена, реже -урокиназа), а также хирургических методов лечения (тромбэктомия, катетер-опосредованная тромбоэкс-тракция) [20,21]. В данном клиническом случае тромбоз не приво-дил к развитию острой печеночной недостаточности и не угрожал жизни, но, учитывая вероятность увели-чения размеров тромба, несмотря на тромбоцитопе-нию, возникала необходимость раннего применения антикоагулянтной терапии.…”

Análise de custo-efetividade da rivaroxabana versus enoxaparina no tratamento da trombose venosa profunda em pacientes com câncer ginecológico

“…A trombose venosa profunda (TVP) é uma complicação comum em pacientes com câncer, associada a importantes taxas de morbimortalidade e com elevados custos em saúde (Lee et al, 2013). Pacientes com câncer possuem risco quatro vezes maior de desenvolver TVP em comparação com a população em geral (Carrier et al, 2009).…”