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venous thromboembolism associated with malignancy

Etiology: 1) carcinomas, esp. adenocarcinoma (1,2,3) a) lung cancer b) breast cancer c) ovarian cancer d) testicular cancer e) urologic malignancy f) gastrointestinal cancer - gastric cancer - pancreatic cancer 2) advanced stage cancers, myeloproliferative disorders or myelodysplastic syndrome at highest risk [4] Management: - use LMW heparin rather than warfarin in patients with underlying malignancy based mostly on single trial [5] - LMW heparin & warfarin equivalent [5] - oral anticoagulant edoxaban noninferior to subcutaneous dalteparin for managing venous thromboembolism (VTE) in adults with cancer [6] - direct oral anticoagulants associated with less recurrent VTE but more major bleeding compared with LMW heparins.

General

venous thromboembolism (VTE)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015
  2. Merli G et al Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 134:191, 2001 PMID: 11177331
  3. Trujillo-Santos J et al, Clinical outcome in patients with venous thromboembolism and hidden cancer. Findings from the RIETE Registry. J Thromb Haemost 2008, 6:251 PMID: 18021305
  4. Chee CE et al. Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: A population-based cohort study. Blood 2014 Apr 2 PMID: 24782507 http://bloodjournal.hematologylibrary.org/content/early/2014/04/29/blood-2014-01-549733
  5. Lee AYY et al. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: A randomized clinical trial. JAMA 2015 Aug 18; 314:677. PMID: 26284719
  6. Raskob GE, van Es N, Verhamme P et al Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med. Dec 12, 2017 PMID: 29231094 http://www.nejm.org/doi/full/10.1056/NEJMoa1711948
  7. Mulder FI et al. Direct oral anticoagulants for cancer-associated venous thromboembolism: A systematic review and meta-analysis. Blood 2020 Sep 17; 136:1433 PMID: 32396939 https://ashpublications.org/blood/article-abstract/136/12/1433/455308/Direct-oral-anticoagulants-for-cancer-associated?redirectedFrom=fulltext