Annals of Vascular Surgery

, Volume 5, Issue 2, pp 186–189 | Cite as

Thromboembolic complications in patients with advanced cancer: Anticoagulation versus greenfield filter placement

  • Keith D. Calligaro
  • William S. Bergen
  • Michael J. Haut
  • Ronald P. Savarese
  • Dominic A. DeLaurentis
Papers from the Peripheral Vascular Surgery 1990 Meeting


Thirty patients with Stage III/IV cancer and thromboembolic complications between 1987–89 were reviewed. Twelve patients had a deep venous thrombosis proximal to the calf diagnosed by duplex scanning or contrast venography, 15 patients had a pulmonary embolism diagnosed by a high-probability pulmonary ventilation/perfusion scan or arteriogram, and three patients had both deep vein thrombosis and pulmonary embolism. Patients were treated primarily with anticoagulation (Group A =20 patients) or a Greenfield filter (Group B=10 patients). Seventy-five percent (15/20) of the Group A patients developed 19 bleeding or thrombosis-related complications: major bleeding (7), recurrent deep venous thrombosis/pulmonary embolism (4), inability to attain consistent therapeutic anticoagulation levels (3), heparininduced thrombocytopenia (3), or progression of deep vein thrombosis (2). A Greenfield filter was eventually placed in 10 (50%) of the Group A patients without complications. Thirty percent (3/10) of the Group B patients developed progression of deep vein thrombosis that required anticoagulation. One other Group B patient died due to a guidewire-induced arrhythmia. Although patients with advanced cancers and venous thromboembolic disease have a high complication rate with either treatment, initial treatment with a Greenfield filter appears more definitive. Anticoagulation should be reserved for patients with progressive, symptomatic deep vein thromboses after placement of a filter.

Key words

Deep venous thrombosis cancer anticoagulation Greenfield filter pulmonary embolism 


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  1. 1.
    SCHWARTZBERG LS, HOLBERT JM. Hemorrhagic and thrombotic abnormalities of cancer.Crit Care Clin 1988;4:107–128.PubMedGoogle Scholar
  2. 2.
    GREENFIELD LJ. Current indications for and results of Greenfield filter placement.J Vasc Surg 1984;1:502–504.CrossRefPubMedGoogle Scholar
  3. 3.
    MOORE FD, OSTEEN RT, KARP DD, et al. Anticoagulants, venous thromboembolism, and the cancer patient.Arch Surg 1981;116:405–407.PubMedGoogle Scholar
  4. 4.
    CANTELMO NL, MENZOIAN JO, LO GERFO FW, et al. Clinical experience with vena caval filters in high-risk cancer patients.Cancer 1982;50:341–344.PubMedGoogle Scholar
  5. 5.
    SCHULMAN S, LOCKNER D. Relationship between thromboembolic complications and intensity of treatment during long-term prophylaxis with oral anticoagulants following DVT.Thromb Haemost 1985;53:137–140.PubMedGoogle Scholar
  6. 6.
    DE LARIA GA, HUNTER JA, SERRY C, et al. Thromboembolism and cancer: treatment with the Hunter balloon.J Vasc Surg 1984;1:670–674.CrossRefPubMedGoogle Scholar
  7. 7.
    MENZOIAN JO, SEQUEIRA JC, DOYLE JE, et al. Therapeutic and clinical course of deep vein thrombosis.Am J Surg 1983;146:581–585.CrossRefPubMedGoogle Scholar
  8. 8.
    PEUSCHER FW. Thrombosis and bleeding in cancer patients.Neth J Med 1981;24:23–35.PubMedGoogle Scholar
  9. 9.
    KANTER B, MOSER KM. The Greenfield vena cava filter.Chest 1988;93:170–175.PubMedCrossRefGoogle Scholar
  10. 10.
    WHITNEY BA, KERSTEIN MD. Thrombocytopenia and cancer: use of the Kim-Ray Greenfield filter to prevent thromboembolism.South Med J 1987;80:1246–1248.PubMedGoogle Scholar
  11. 11.
    OLIN JW, YOUNG JR, GRAOR RA, et al. Treatment of deep vein thrombosis and pulmonary emboli in patients with primary and metastatic brain tumors. Anticoagulants or inferior vena cava filter?Arch Intern Med 1987;147:2177–2179.CrossRefPubMedGoogle Scholar
  12. 12.
    WALSH DV, DOWNING S, NAUTA R, et al. Metastatic cancer. A relative contraindication to vena cava filter placement.Cancer 1987;59:161–163.PubMedGoogle Scholar
  13. 13.
    BYRD R, DIVERTIE M, SPITTELL J. Bronchogenic carcinoma and thromboembolic disease.JAMA 1967;202:1019–1022.CrossRefPubMedGoogle Scholar
  14. 14.
    WAJIMA T. Thrombophlebitis in cancer patients.Ann NY Acad Sci 1981;370:138–144.PubMedGoogle Scholar
  15. 15.
    OSTER MW. Thrombophlebitis and cancer.Angiology 1976;27:557–559.PubMedGoogle Scholar
  16. 16.
    SONS HU. Pulmonary embolism and cancer: predisposition to venous thrombosis and embolism as a paraneoplastic syndrome.J Surg Oncol 1989;40:100–106.PubMedGoogle Scholar
  17. 17.
    JONES B, FINK JA, DONOVAN DL, et al. Analysis of benefit of anticoagulation after placement of Kimray-Greenfield filter.Surg Gynecol Obstet 1989;169:400–402.PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1991

Authors and Affiliations

  • Keith D. Calligaro
    • 1
  • William S. Bergen
    • 1
  • Michael J. Haut
    • 1
  • Ronald P. Savarese
    • 1
  • Dominic A. DeLaurentis
    • 1
  1. 1.Section of Vascular Surgery, and Departments of Medicine and PathologyPennsylvania Hospital/University of Pennsylvania School of MedicinePhiladelphia

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