Abstract
The presence of cancer increases the risk of deep vein thrombosis (DVT), DVT recurrence,
and treatment-related bleeding, and therefore offers distinctive clinical considerations
when planning treatment. Anticoagulation with a low-molecular-weight heparin is the
preferred initial and long-term therapy in cancer patients. Inferior vena cava filters
may be used judiciously for patients with cancer-related DVT who have contraindications
to anticoagulation or who exhibit breakthrough pulmonary embolism (PE) despite anticoagulation,
but should be removed when the PE risk is felt to subside. Because moderate-quality
evidence suggests that the use of catheter-directed thrombolysis (CDT) can prevent
the postthrombotic syndrome, cancer patients with acute iliofemoral DVT, low expected
bleeding risk, and good functional status may reasonably be considered for CDT if
DVT-related sequelae are likely to be a dominant contributor to the patient's clinical
condition, functional status, and quality of life. In selected patients who have chronic
venous symptoms from mass/nodal compression of the pelvic veins, endovascular stent
placement may provide symptom relief. As current recommendations are based on very
limited data, further studies would be welcome to better delineate the most appropriate
use of endovascular therapies in patients with cancer.
Keywords
deep vein thrombosis - cancer - thrombolysis - anticoagulation - stent
