Venous thromboembolism

Abstract

Emergency physicians routinely care for oncology patients who are dually afflicted with venous thromboembolic disease. This dual diagnosis affects 5 % of all cancer patients in the USA and worsens both prognosis for the initial cancer diagnosis and the outcomes from the thrombosis. Several cancers are at particularly high risk for subsequent thrombosis, including adenocarcinoma, myeloma, and promyelocytic leukemia. Chemotherapeutic agents, such as 5-FU, thalidomide derivatives, and asparaginase, independently increase the risk of thrombosis. Further, active cancer complicates the diagnostic work-up by inherently imposing a moderate or higher risk of thrombosis and causing more false-positive testing with the D-dimer assay. Cancer leads to incidental pulmonary embolism diagnosis found on about 2-4 % of computerized tomographic scanning done for cancer staging and surveillance, and the current practice is to treat these patients with full-dose anticoagulation. Treatment requires unfractionated heparin during the entire time that cancer is thought to be active, and cancer patients have a higher rate of bleeding during treatment. Advanced therapy, such as systemic or catheter-directed fibrinolysis, has not been subjected to rigorous testing in clinical trials of cancer patients.