Thrombosis, anticoagulation and outcomes in malignant superior vena cava syndrome


Anticoagulation is often used in superior vena cava syndrome (SVCS) associated with cancer (i.e malignant SVCS), even without thrombosis, but its effect on outcomes has not been reported. We aimed to determine factors and outcomes associated with thrombosis and anticoagulation in malignant SVCS. Patients with malignant SVCS diagnosed on computerized tomography (CT) were retrospectively included, indexed at diagnosis and followed for 6 months using medical records. The cohort included 183 patients with malignant SVCS of which 153 (84%) were symptomatic. Thirty of the 127 patients (24%) with a reviewable baseline CT had thrombosis of the SVC or tributaries at diagnosis. Patients with baseline thrombosis more often had symptomatic SVCS (p < 0.01). 70% (21/30) of patients with thrombosis and 52% (49/97) of those without thrombosis at baseline received anticoagulation, most often at therapeutic doses. Thrombosis occurred in 5/39 patients with anticoagulation (13%) compared to 2/18 (11%) of those without, during follow-up (p = 0.85). Anticoagulation was associated with a reduction in risk of SVC stent placement during follow-up that did not reach statistical significance (HR 0.47, 95% CI 0.2–1.13, p = 0.09). Major bleeding occurred in 7 (4%) patients, six of whom received anticoagulation (four therapeutic and two intermediate dose). Neither thrombosis nor anticoagulation affected survival. Anticoagulation is commonly used as primary prevention but its benefit remains to be proven. The role of reduced-dose anticoagulation in non-thrombotic malignant SVCS should be prospectively assessed.

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  1. 1.

    Rice TW, Rodriguez RM, Light RW (2006) The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 85:37–42.

    Article  Google Scholar 

  2. 2.

    Abner A (1993) Approach to the patient who presents whh superior vena cava obstruction. Chest 103:394S–397S.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Perez-Soler R, McLaughlin P, Velasquez WS et al (1984) Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. J Clin Oncol 2:260–266.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Armstrong BA, Perez CA, Simpson JR, Hederman MA (1987) Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys 13:531–539.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Schraufnagel DE, Hill R, Leech JA, Pare JA (1981) Superior vena caval obstruction. Is it a medical emergency? Am J Med 70:1169–1174

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Kim Y-I (2004) Endovascular stenting as a first choice for the palliation of superior vena cava syndrome. J Korean Med Sci 19:519–522

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Marcy PY, Magné N, Bentolila F et al (2001) Superior vena cava obstruction: is stenting necessary? Support Care Cancer 9:103–107

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Lanciego C, Pangua C, Chacon JI, Velasco J, Boy RC, Viana A, Cerezo S, Garcia LG (2009) Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. Am J Roentgenol 193:549–558

    Article  Google Scholar 

  9. 9.

    Lepper PM, Ott SR, Hoppe H et al (2011) Superior vena cava syndrome in thoracic malignancies. Respir Care 56:653–666.

    Article  PubMed  Google Scholar 

  10. 10.

    Wilson LD, Detterbeck FC, Yahalom J (2007) Superior vena cava syndrome with malignant causes. N Engl J Med 356:1862–1869

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Yu JB, Wilson LD, Detterbeck FC (2008) Superior vena cava syndrome—a proposed classification system and algorithm for management. J Thorac Oncol 3:811–814.

    Article  PubMed  Google Scholar 

  12. 12.

    Schulman S, Anger SU, Bergqvist D et al (2010) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost 8:202–204.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Mónaco RG, Bertoni H, Pallota G et al (2003) Use of self-expanding vascular endoprostheses in superior vena cava syndrome. Eur J Cardio-thoracic Surg 24:208–211.

    Article  Google Scholar 

  14. 14.

    Morin S, Grateau A, Reuter D et al (2017) Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer.

    Article  PubMed  Google Scholar 

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The authors express their gratitude to Vincent ten Cate for his critical review of the manuscript.


This work was supported by the Paul Davidoff Foundation for the Ofek Program in collaboration with the Tel-Aviv University.

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Correspondence to Avi Leader.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ratzon, R., Tamir, S., Friehmann, T. et al. Thrombosis, anticoagulation and outcomes in malignant superior vena cava syndrome. J Thromb Thrombolysis 47, 121–128 (2019).

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  • Superior vena cava syndrome
  • Malignancy
  • Thrombosis
  • Anticoagulation