EVALUATION AND MANAGEMENT OF VENOUS THROMBOEMBOLISM IN CANCER PATIENTS

Suhag V.*, Sunita B. S., Vats P., Singh V. K., Pandya T., Lohia N.6and Tiwari M.

ABSTRACT

Venous thromboembolism (VTE) is a frequent complication of cancer associated with morbidity, mortality, increased hospitalizations and higher health care costs. The risk of VTE is 4- to 7-fold higher in patients with cancer than in those without cancer. Reported rates of VTE in patients with cancer have increased in recent years likely reflecting, in part, improved diagnosis with sophisticated imaging techniques as well as the impact of more aggressive cancer diagnosis, staging, and treatment. Various therapeutic interventions, such as surgery, chemotherapy, hormonal therapy, targeted therapeutic strategies as well as the frequent use of indwelling catheters and other invasive procedures also place cancer patients at increased risk of VTE. It is important to assess the risk of thrombotic events in cancer patients and administer effective prophylaxis and treatment to reduce morbidity and mortality, and improves patients’ quality of life. Low molecular weight heparin is the first-line treatment for VTE, as an effective and safe means for prophylaxis and treatment. For long term anticoagulation, LMWH for at least 6 months is preferred due to improved efficacy over Vitamin K antagonists. Vitamin K antagonists are an acceptable alternative for long-term therapy if LMWH is not available. Oral anticoagulation therapy with warfarin is preferable to no therapy. Use of novel oral anticoagulants for either prevention or treatment of VTE in cancer patients is not recommended at this time. Oncologists should educate patients regarding the warning signs and symptoms of VTE, including leg swelling or pain, sudden-onset chest pain, and shortness of breath.

Keywords: Cancer, thromboembolism, risk assessment, prophylaxis, management.