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Prevention and Management of Venous Thromboembolism in the Cancer Patient

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Oncologic Critical Care

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Abstract

Venous thromboembolic disease is notably one of the leading causes of death in cancer patients and is a cause of significant morbidity and mortality. Malignancy-related physiologic abnormalities and certain anticancer therapies can lead to hypercoagulability. Critical illness also adds to the risk for venous thromboembolism in this cohort due to factors such as immobility and central venous catheters. Thus critically ill cancer patients are especially vulnerable to developing a venous thromboembolism, and a focus on prevention as well as clinical suspicion should be an initially high priority. Once a diagnosis is made, however, management of venous thromboembolism in oncology patients can be especially complex given the wide array of cardiac and pulmonary abnormalities that often coexist in this patient population, as well as the common contraindications that exist to standard therapy and anticoagulation. For critically ill patients with intermediate or high-risk pulmonary emboli, alternatives to anticoagulation or thrombolytic therapy need to be understood in the event that a contraindication such as severe thrombocytopenia or a high risk for bleeding exists.

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References

  1. Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, Cartier JC, Ferretti G, Schwebel C, Timsit JF. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Crit Care. 2015;19:287.

    Article  Google Scholar 

  2. Cook D, Crowther M, Meade M, Rabbat C, Griffith L, Schiff D, Geerts W, Guyatt G. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med. 2005;33(7):1565–71.

    Article  Google Scholar 

  3. Levitan N, Dowlati A, Remick SC, Tahsildar HI, Sivinski LD, Beyth R, Rimm AA. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine. 1999;78(5):285–91.

    Article  CAS  Google Scholar 

  4. Cronin-Fenton DP, Sondergaard F, Pedersen LA, Fryzek JP, Cetin K, Acquavella J, Baron JA, Sorensen HT. Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997–2006. Br J Cancer. 2010;103(7):947–53.

    Article  CAS  Google Scholar 

  5. Merkow RP, Bilimoria KY, McCarter MD, Cohen ME, Barnett CC, Raval MV, Caprini JA, Gordon HS, Ko CY, Bentrem DJ. Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis. Ann Surg. 2011;254(1):131–7.

    Article  Google Scholar 

  6. Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, Marchiori A, Sabbion P, Prins MH, Noventa F, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484–8.

    Article  CAS  Google Scholar 

  7. Ibrahim EH, Iregui M, Prentice D, Sherman G, Kollef MH, Shannon W. Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis. Crit Care Med. 2002;30(4):771–4.

    Article  Google Scholar 

  8. Group PIftCCCT, the A, New Zealand Intensive Care Society Clinical Trials G, Cook D, Meade M, Guyatt G, Walter S, Heels-Ansdell D, Warkentin TE, Zytaruk N, et al. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med. 2011;364(14):1305–14.

    Article  Google Scholar 

  9. Moser KM, LeMoine JR, Nachtwey FJ, Spragg RG. Deep venous thrombosis and pulmonary embolism. Frequency in a respiratory intensive care unit. JAMA. 1981;246(13):1422–4.

    Article  CAS  Google Scholar 

  10. Cade JF. High risk of the critically ill for venous thromboembolism. Crit Care Med. 1982;10(7):448–50.

    Article  CAS  Google Scholar 

  11. Fraisse F, Holzapfel L, Couland JM, Simonneau G, Bedock B, Feissel M, Herbecq P, Pordes R, Poussel JF, Roux L. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1109–14.

    Article  CAS  Google Scholar 

  12. Gale AJ, Gordon SG. Update on tumor cell procoagulant factors. Acta Haematol. 2001;106(1–2):25–32.

    Article  CAS  Google Scholar 

  13. Oppelt P, Betbadal A, Nayak L. Approach to chemotherapy-associated thrombosis. Vasc Med. 2015;20(2):153–61.

    Article  CAS  Google Scholar 

  14. Seng S, Liu Z, Chiu SK, Proverbs-Singh T, Sonpavde G, Choueiri TK, Tsao CK, Yu M, Hahn NM, Oh WK, et al. Risk of venous thromboembolism in patients with cancer treated with Cisplatin: a systematic review and meta-analysis. J Clin Oncol. 2012;30(35):4416–26.

    Article  CAS  Google Scholar 

  15. Amir E, Seruga B, Niraula S, Carlsson L, Ocana A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst. 2011;103(17):1299–309.

    Article  CAS  Google Scholar 

  16. Grace RF, Dahlberg SE, Neuberg D, Sallan SE, Connors JM, Neufeld EJ, Deangelo DJ, Silverman LB. The frequency and management of asparaginase-related thrombosis in paediatric and adult patients with acute lymphoblastic leukaemia treated on Dana-Farber Cancer Institute consortium protocols. Br J Haematol. 2011;152(4):452–9.

    Article  Google Scholar 

  17. Zangari M, Anaissie E, Barlogie B, Badros A, Desikan R, Gopal AV, Morris C, Toor A, Siegel E, Fink L, et al. Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy. Blood. 2001;98(5):1614–5.

    Article  CAS  Google Scholar 

  18. Weijl NI, Rutten MF, Zwinderman AH, Keizer HJ, Nooy MA, Rosendaal FR, Cleton FJ, Osanto S. Thromboembolic events during chemotherapy for germ cell cancer: a cohort study and review of the literature. J Clin Oncol. 2000;18(10):2169–78.

    Article  CAS  Google Scholar 

  19. Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care. 2018;6:16.

    Article  Google Scholar 

  20. Streiff MB, Holmstrom B, Ashrani A, Bockenstedt PL, Chesney C, Eby C, Fanikos J, Fenninger RB, Fogerty AE, Gao S, et al. Cancer-associated venous thromboembolic disease, version 1.2015. J Natl Compr Cancer Netw. 2015;13(9):1079–95.

    Article  Google Scholar 

  21. NCCN Guidelines for Cancer Associated Venous Thromboembolic Disease (VTE) V.1.2018. https://www.nccn.org/professionals/physician_gls/default.aspx#vte

  22. McLeod AG, Geerts W. Venous thromboembolism prophylaxis in critically ill patients. Crit Care Clin. 2011;27(4):765–80, v.

    Article  Google Scholar 

  23. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest. 1995;108(4):978–81.

    Article  CAS  Google Scholar 

  24. Kearon C, Ginsberg JS, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med. 1998;129(12):1044–9.

    Article  CAS  Google Scholar 

  25. Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Buller HR, Turpie AG, Powers P, Kinch D, Dodd PE, et al. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial. Ann Intern Med. 1985;102(1):21–8.

    Article  CAS  Google Scholar 

  26. Fraser JD, Anderson DR. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology. 1999;211(1):9–24.

    Article  CAS  Google Scholar 

  27. Crowther MA, Cook DJ, Griffith LE, Meade M, Hanna S, Rabbat C, Bates SM, Geerts W, Johnston M, Guyatt G. Neither baseline tests of molecular hypercoagulability nor D-dimer levels predict deep venous thrombosis in critically ill medical-surgical patients. Intensive Care Med. 2005;31(1):48–55.

    Article  CAS  Google Scholar 

  28. Kory PD, Pellecchia CM, Shiloh AL, Mayo PH, DiBello C, Koenig S. Accuracy of ultrasonography performed by critical care physicians for the diagnosis of DVT. Chest. 2011;139(3):538–42.

    Article  Google Scholar 

  29. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136(9):691–700.

    Article  Google Scholar 

  30. Miniati M, Monti S, Pratali L, Di Ricco G, Marini C, Formichi B, Prediletto R, Michelassi C, Di Lorenzo M, Tonelli L, et al. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med. 2001;110(7):528–35.

    Article  CAS  Google Scholar 

  31. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386–9.

    Article  CAS  Google Scholar 

  32. Konstantinides SV. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(45):3145–6.

    Article  Google Scholar 

  33. Konstantinides S, Geibel A, Kasper W, Olschewski M, Blumel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation. 1998;97(19):1946–51.

    Article  CAS  Google Scholar 

  34. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, Kumbhani DJ, Mukherjee D, Jaff MR, Giri J. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014;311(23):2414–21.

    Article  Google Scholar 

  35. Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J. 2015;36(10):605–14.

    Article  CAS  Google Scholar 

  36. Keeling WB, Leshnower BG, Lasajanak Y, Binongo J, Guyton RA, Halkos ME, Thourani VH, Lattouf OM. Midterm benefits of surgical pulmonary embolectomy for acute pulmonary embolus on right ventricular function. J Thorac Cardiovasc Surg. 2016;152(3):872–8.

    Article  Google Scholar 

  37. Meneveau N, Seronde MF, Blonde MC, Legalery P, Didier-Petit K, Briand F, Caulfield F, Schiele F, Bernard Y, Bassand JP. Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest. 2006;129(4):1043–50.

    Article  Google Scholar 

  38. Clarke DB, Abrams LD. Pulmonary embolectomy: a 25 year experience. J Thorac Cardiovasc Surg. 1986;92(3 Pt 1):442–5.

    CAS  PubMed  Google Scholar 

  39. Dauphine C, Omari B. Pulmonary embolectomy for acute massive pulmonary embolism. Ann Thorac Surg. 2005;79(4):1240–4.

    Article  Google Scholar 

  40. Lyman GH. Venous thromboembolism in the patient with cancer: focus on burden of disease and benefits of thromboprophylaxis. Cancer. 2011;117(7):1334–49.

    Article  Google Scholar 

  41. Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166(4):458–64.

    Article  Google Scholar 

  42. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, Rauber K, Iversen S, Redecker M, Kienast J. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30(5):1165–71.

    Article  CAS  Google Scholar 

  43. Meyer et al. Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism. NEJM 2014;370:1402–1411

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sajid A. Haque & Nisha K. Rathi

Authors
  1. Sajid A. Haque
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  2. Nisha K. Rathi
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Correspondence to Sajid A. Haque .

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Editors and Affiliations

  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

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Haque, S.A., Rathi, N.K. (2020). Prevention and Management of Venous Thromboembolism in the Cancer Patient. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_113

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  • DOI: https://doi.org/10.1007/978-3-319-74588-6_113

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74587-9

  • Online ISBN: 978-3-319-74588-6

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