Advertisement

Prevention and Management of Venous Thromboembolism in the Cancer Patient

  • Sajid A. HaqueEmail author
  • Nisha K. Rathi
Reference work entry

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.

Keywords

Deep venous thrombosis Pulmonary embolism Venous thromboembolism Cancer Prevention Treatment 

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 10.
    Cade JF. High risk of the critically ill for venous thromboembolism. Crit Care Med. 1982;10(7):448–50.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 12.
    Gale AJ, Gordon SG. Update on tumor cell procoagulant factors. Acta Haematol. 2001;106(1–2):25–32.CrossRefGoogle Scholar
  13. 13.
    Oppelt P, Betbadal A, Nayak L. Approach to chemotherapy-associated thrombosis. Vasc Med. 2015;20(2):153–61.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 19.
    Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care. 2018;6:16.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 21.
    NCCN Guidelines for Cancer Associated Venous Thromboembolic Disease (VTE) V.1.2018. https://www.nccn.org/professionals/physician_gls/default.aspx#vte
  22. 22.
    McLeod AG, Geerts W. Venous thromboembolism prophylaxis in critically ill patients. Crit Care Clin. 2011;27(4):765–80, v.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 26.
    Fraser JD, Anderson DR. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology. 1999;211(1):9–24.CrossRefGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 29.
    Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136(9):691–700.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 32.
    Konstantinides SV. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(45):3145–6.CrossRefGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.CrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 38.
    Clarke DB, Abrams LD. Pulmonary embolectomy: a 25 year experience. J Thorac Cardiovasc Surg. 1986;92(3 Pt 1):442–5.PubMedGoogle Scholar
  39. 39.
    Dauphine C, Omari B. Pulmonary embolectomy for acute massive pulmonary embolism. Ann Thorac Surg. 2005;79(4):1240–4.CrossRefGoogle Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 43.
    Meyer et al. Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism. NEJM 2014;370:1402–1411Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Critical CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations