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Objective: Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant source of morbidity and mortality in individuals with malignancies. Thromboprophylaxis is commonly employed in the management of most cancer patients, with the most common side effect being bleeding. It is not uncommon for patients to experience a recurrence of VTE during their treatment, highlighting a notable gap in the available evidence on this issue.
Case: A 67-year-old male patient, actively undergoing chemotherapy for lung adenocarcinoma and initiated on low molecular weight heparin (LMWH) due to the development of PE, presented to the emergency department with DVT as a consequence of irregular use of anticoagulant injections. The patient, after being re-administered heparin, subsequently presented with intracranial hemorrhage on the 5th day post-discharge, ultimately leading to a fatal outcome.
Conclusion: Both cancer patients and the elderly are at a heightened risk of experiencing VTE recurrence. The initiation of anticoagulation treatment elevates the risk of bleeding, particularly within the first ten days. Despite the frequent presentation of VTE recurrence in cancer patients at emergency departments, it remains underreported.
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Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5(3):632-4. DOI: https://doi.org/10.1111/j.1538-7836.2007.02374.x
Bullano MF, Willey V, Hauch O, Wygant G, Spyropoulos AC, Hoffman L. Longitudinal evaluation of health plan cost per venous thromboembolism or bleed event in patients with a prior venous thromboembolism event during hospitalization. J Manag Care Pharm. 2005;11(8):663-73. DOI: https://doi.org/10.18553/jmcp.2005.11.8.663
Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484-8. DOI: https://doi.org/10.1182/blood-2002-01-0108
Key NS, Khorana AA, Mackman N, McCarty OJ, White GC, Francis CW, et al. Thrombosis in Cancer: Research Priorities Identified by a National Cancer Institute/National Heart, Lung, and Blood Institute Strategic Working Group. Cancer Res. 2016;76(13):3671-5. DOI: https://doi.org/10.1158/0008-5472.CAN-15-3100
Weitz JI, Haas S, Ageno W, Goldhaber SZ, Turpie AGG, Goto S, et al. Cancer associated thrombosis in everyday practice: perspectives from GARFIELD-VTE. J Thromb Thrombolysis. 2020;50(2):267-77. DOI: https://doi.org/10.1007/s11239-020-02180-x
Marks MA, Engels EA. Venous thromboembolism and cancer risk among elderly adults in the United States. Cancer Epidemiol Biomarkers Prev. 2014;23(5):774-83. DOI: https://doi.org/10.1158/1055-9965.EPI-13-1138
Carrier M, Khorana AA, Moretto P, Le Gal G, Karp R, Zwicker JI. Lack of evidence to support thromboprophylaxis in hospitalized medical patients with cancer. Am J Med. 2014;127(1):82-6.e1. DOI: https://doi.org/10.1016/j.amjmed.2013.09.015
Wun T, White RH. Epidemiology of cancer-related venous thromboembolism. Best Pract Res Clin Haematol. 2009;22(1):9-23. DOI: https://doi.org/10.1016/j.beha.2008.12.001
Donnellan E, Kevane B, Bird BR, Ainle FN. Cancer and venous thromboembolic disease: from molecular mechanisms to clinical management. Curr Oncol. 2014;21(3):134-43. DOI: https://doi.org/10.3747/co.21.1864
Muñoz A, Gallardo E, Agnelli G, Crespo C, Forghani M, Arumi D, et al. Cost-effectiveness of direct oral anticoagulants compared to low-molecular-weight-heparins for treatment of cancer associated venous thromboembolism in Spain. J Med Econ. 2022;25(1):840-7. DOI: https://doi.org/10.1080/13696998.2022.2087998
Sidahmed S, Abdalla A, Kheiri B, Bala A, Salih M, Bachuwa G, et al. Anticoagulants for the treatment of venous thromboembolism in patients with cancer: A comprehensive systematic review, pairwise and network meta-analysis. Crit Rev Oncol Hematol. 2020;152:103005. DOI: https://doi.org/10.1016/j.critrevonc.2020.103005
Farge D, Frere C, Connors JM, Khorana AA, Kakkar A, Ay C, et al. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19. Lancet Oncol. 2022;23(7):e334-e47.
Ozaslan E, Ozkan M, Cicin I, Benekli M, Kocer M, Uysal M, et al. Effectiveness and Safety of LMWH Treatment in Patients With Cancer Diagnosed With Non-High-Risk Venous Thromboembolism: Turkish Observational Study (TREBECA). Clin Appl Thromb Hemost. 2018;24(6):973-9. DOI: https://doi.org/10.1177/1076029617753538