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Diagnosis and initial treatment of venous thromboembolism in patients with cancer.
J Clin Oncol. 2009 Oct 10; 27(29):4889-94.JC

Abstract

PURPOSE

Venous thromboembolism (VTE) is a common complication of cancer and its therapy. The purpose of this article is to review the diagnosis and initial treatment of VTE in the patient with cancer.

METHODS

I conducted a survey of the English-language literature on topics relevant to the diagnosis and initial treatment of VTE in patients with cancer.

RESULTS

Patients with cancer are at increased risk for VTE because of the presence of multiple risk factors for thrombotic disease. The most common signs and symptoms of VTE as well as the utility of clinical prediction rules and D-dimer testing in the diagnosis of VTE in the patient with cancer are reviewed. Duplex ultrasound and computer tomography angiography are the primary objective diagnostic modalities for VTE. Low molecular weight heparin is the preferred initial therapy for VTE. Until further data emerge, thrombolysis and vena cava filters should be reserved for patients in whom anticoagulation is insufficient or contraindicated. Outpatient management is feasible for carefully selected patients with cancer with deep vein thrombosis (DVT) and low-risk pulmonary embolism. Anticoagulation is the preferred initial therapy for cancer patients with central venous catheter-associated DVT, calf DVT, and unsuspected VTE.

CONCLUSION

Optimal initial management of VTE in patients with cancer entails maintaining a high index of suspicion for thrombotic disease, confirming diagnostic suspicions with objective testing and evidence-based use of anticoagulation, and adjunctive therapeutic modalities (thrombolysis, vena cava interruption, venous stenting). Further investigation of initial diagnostic and treatment strategies for VTE focusing on patients with cancer are warranted.

Authors+Show Affiliations

Johns Hopkins Anticoagulation Service and Outpatient Clinics, Special Coagulation Laboratory, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. mstreif@jhmi.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19738109

Citation

Streiff, Michael B.. "Diagnosis and Initial Treatment of Venous Thromboembolism in Patients With Cancer." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 27, no. 29, 2009, pp. 4889-94.
Streiff MB. Diagnosis and initial treatment of venous thromboembolism in patients with cancer. J Clin Oncol. 2009;27(29):4889-94.
Streiff, M. B. (2009). Diagnosis and initial treatment of venous thromboembolism in patients with cancer. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 27(29), 4889-94. https://doi.org/10.1200/JCO.2009.23.5788
Streiff MB. Diagnosis and Initial Treatment of Venous Thromboembolism in Patients With Cancer. J Clin Oncol. 2009 Oct 10;27(29):4889-94. PubMed PMID: 19738109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and initial treatment of venous thromboembolism in patients with cancer. A1 - Streiff,Michael B, Y1 - 2009/09/08/ PY - 2009/9/10/entrez PY - 2009/9/10/pubmed PY - 2009/11/3/medline SP - 4889 EP - 94 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 27 IS - 29 N2 - PURPOSE: Venous thromboembolism (VTE) is a common complication of cancer and its therapy. The purpose of this article is to review the diagnosis and initial treatment of VTE in the patient with cancer. METHODS: I conducted a survey of the English-language literature on topics relevant to the diagnosis and initial treatment of VTE in patients with cancer. RESULTS: Patients with cancer are at increased risk for VTE because of the presence of multiple risk factors for thrombotic disease. The most common signs and symptoms of VTE as well as the utility of clinical prediction rules and D-dimer testing in the diagnosis of VTE in the patient with cancer are reviewed. Duplex ultrasound and computer tomography angiography are the primary objective diagnostic modalities for VTE. Low molecular weight heparin is the preferred initial therapy for VTE. Until further data emerge, thrombolysis and vena cava filters should be reserved for patients in whom anticoagulation is insufficient or contraindicated. Outpatient management is feasible for carefully selected patients with cancer with deep vein thrombosis (DVT) and low-risk pulmonary embolism. Anticoagulation is the preferred initial therapy for cancer patients with central venous catheter-associated DVT, calf DVT, and unsuspected VTE. CONCLUSION: Optimal initial management of VTE in patients with cancer entails maintaining a high index of suspicion for thrombotic disease, confirming diagnostic suspicions with objective testing and evidence-based use of anticoagulation, and adjunctive therapeutic modalities (thrombolysis, vena cava interruption, venous stenting). Further investigation of initial diagnostic and treatment strategies for VTE focusing on patients with cancer are warranted. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/19738109/Diagnosis_and_initial_treatment_of_venous_thromboembolism_in_patients_with_cancer_ L2 - https://ascopubs.org/doi/10.1200/JCO.2009.23.5788?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -