Management of Venous Thromboembolism: Prevention and Treatment in Patients with Cancer
Patient Guideline Summary
- Venous thromboembolism (VTE) describes blood clots forming in veins and traveling, usually into the lungs.
- We will use the abbreviation DVT throughout this summary to refer to deep venous thrombosis and PE to refer to pulmonary embolism.
- There are two conditions in view here.
- DVT: blood clots in veins, most commonly in a leg. Severe cases threaten blood circulation in the affected limb.
- Embolism: the movement of a clot, usually into a lung. Large or multiple emboli can be life-threatening.
- Cancer greatly increases the risk of VTE and PE.
- Symptoms of DVT include pain, swelling, warmth, and discoloration of the affected limb.
- Symptoms of PE include difficulty breathing, chest discomfort, heart pounding, faintness, and coughing up blood.
- This patient summary focuses on the management of venous thromboembolism in patients with cancer.
All treatment decisions are based on the individual circumstances of each patient.
- Uncomplicated DVT and PE can be managed at home. More severe cases or otherwise unhealthy patients may require hospitalization.
- Medical treatment entails preventing the extension of the clot or dissolving the clot, or both.
- Thrombolysis (clot-dissolving) can be accomplished by giving certain drugs intravenously or through a catheter directly into a clot.
- Anticoagulation prevents further clotting by “thinning” the blood. There are several classes of anticoagulants.
- Injectable unfractionated heparin (UFH), low-molecular-weight heparin (LMWH)
- Fondaparinux injection
- Oral agents:
- Vitamin K antagonists (blockers)
- Rivaroxaban, apixaban, edoxaban and dabigatran
- Mechanical treatments: These devices help pump blood out of the legs.
- Intermittent ankle flexers
- Pulsatile foot pumps
- Intermittent pneumatic compression devices
- Graduated compression stockings
- Surgical treatments:
- Open removal of clots
- Catheter placement of a filter above the clot to prevent it from moving into the lungs
- Duration of medical treatment is an individual decision weighing the severity of the condition, the risk of continued medication, and the general health of each patient.
- ASH: American Society Of Hematology
- DVT: Deep Venous Thrombosis
- IVC: Inferior Vena Cava
- LMWH: Low Molecular Weight Heparin
- PE: Pulmonary Embolism
- UFH: Unfractionated Heparin
- VTE: Venous Thromboembolism