Thrombosis in Cancer: A Medical Professional's Guide to Cancer Associated Thrombosis

Management of Cancer-Associated Thrombosis

Author(s): Lilit Karapetyan, Calvin Abro, Seda Grigoryan and Prajwal Dhakal * .

Pp: 62-84 (23)

DOI: 10.2174/9781681087849121010010

* (Excluding Mailing and Handling)

Abstract

Anticoagulation options remain the same in those with or without cancer. It is used for the prevention and/or treatment of thrombus in those with low bleeding risk. No anticoagulation is recommended in active bleeding, recent surgery, pre-existing bleeding disorders, coagulopathy, or platelet count <50,000/microL. The immediate treatment options include low molecular weight heparin (LMWH) or unfractionated heparin (UFH) plus long-term management with LMWH, vitamin K antagonists, or direct oral anticoagulants. The acute VTE with malignancy requires initial anticoagulation therapy for 5-10 days, LMWH is the medication of choice unless contraindicated. The patient characteristics such as renal function, compliance, diet adherence determine drug selection. Fondaparinux and direct oral anticoagulants can also be initial treatment choices. UFH is preferred if a rapid anticoagulation reversal is required in circumstances such as renal disease, high bleeding risk, and for patients undergoing procedures. The factor Xa inhibitors are currently approved for initial DVT and acute PE treatment. They eliminate the need to monitor anticoagulation effectiveness. For those who are poor candidates for long-term LMWH, indirect oral anticoagulant (warfarin) is acceptable for chronic management. DOACs can be an alternative for those unable to use LMWH for reasons such as renal impairment (creatinine clearance less than 30mL/min), cost, non-compliance, or fear of needles. The duration of anticoagulation treatment is a minimum of 3 months. For those with malignancy and VTE with contraindications to anticoagulants, the only therapeutic option can sometimes be mechanical devices such as inferior vena cava filter (IVCF).


Keywords: Acute VTE, Cancer-associated thrombosis, Chronic anticoagulant malignancy, IVC filter, LMWH in malignancy, Management of VTE in malignancy, Oral anticoagulants, Rivaroxaban, Thrombosis in malignancy.

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      • 11. app/Models/ContentAccess.php:647
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314566706 and j.to_ip >=314566706 )) and ((j.from_date <= 1739835025 and j.to_date >= 1739835025 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14924) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314566706 and j.to_ip >=314566706 )) and ((j.from_date <= 1739835025 and j.to_date >= 1739835025 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14924) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314566706 and j.to_ip >=314566706 )) and ((j.from_date <= 1739835025 and j.to_date >= 1739835025 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14924)
      610μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3072 and `b`.`banner_from_date` <= 1739835025 and `b`.`banner_to_date` >= 1739835025 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.03msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3072
      • 3: 1739835025
      • 4: 1739835025
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='2b0855ab220b16f1d54b0e08aff78fd1'
      200μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    9Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        wyOystid2ZYVkLiVmjT1khVyI4Jc7k8ua7GauRuC
        uc_cart_id
        2b0855ab220b16f1d54b0e08aff78fd1
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14924" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/14924
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:30:25GET/chapter/149241121911