Abstract
Venous thromboembolism (VTE) is a leading cause of cardiovascular death and is associated
with significant morbidity. Patients with cancer, and gastrointestinal (GI) malignancies
in particular, are at increased risk of VTE, increased risk of bleeding with VTE treatment,
and increased risk of recurrent VTE compared with the general population. VTE has
been shown to be a leading cause of death among patients with cancer. This review
will discuss special considerations in the prevention, diagnosis, and management of
VTE in patients with GI malignancies. Given the increased risk of VTE observed in
ambulatory patients with GI malignancies, multiple trials have examined and demonstrated
the efficacy of prophylactic anticoagulation in high-risk patients with cancer undergoing
chemotherapy, particularly in patients with gastric and pancreatic cancers. Patients
with GI malignancies have also played a central role in discussions of the risks and
benefits of the use of direct oral anticoagulants in patients with cancers, with first-line
anticoagulation options expanding to include low-molecular-weight heparin, rivaroxaban,
edoxaban, and apixaban. However, there continue to be concerns regarding an increased
risk of bleeding with edoxaban and rivaroxaban in patients with GI malignancies. In
addition to anticoagulation, individualized risk and benefit analysis should be undertaken
for interventions including inferior vena cava (IVC) filter placement and catheter-directed
thrombolysis in the setting of increased risk of bleeding and recurrent VTE for patients
with GI malignancies. Several unique scenarios that may be seen with GI malignancies,
including incidental VTE, splanchnic vein thrombosis, IVC thrombosis, and iliac vein
compression, require individualized decision making.
Keywords
venous thromboembolism - deep vein thrombosis - pulmonary embolism - cancer - anticoagulation
