Thromboembolic complications in patients with advanced cancer: anticoagulation versus Greenfield filter placement.
Thirty patients with Stage III/IV cancer and thromboembolic complications between 1987-89 were reviewed. Twelve patients had a deep venous thrombosis proximal to the calf diagnosed by duplex scanning or contrast venography, 15 patients had a pulmonary embolism diagnosed by a high-probability pulmonary ventilation/perfusion scan or arteriogram, and three patients had both deep vein thrombosis and pulmonary embolism. Patients were treated primarily with anticoagulation (Group A = 20 patients) or a Greenfield filter (Group B = 10 patients). Seventy-five percent (15/20) of the Group A patients developed 19 bleeding or thrombosis-related complications: major bleeding (7), recurrent deep venous thrombosis/pulmonary embolism (4), inability to attain consistent therapeutic anticoagulation levels (3), heparin-induced thrombocytopenia (3), or progression of deep vein thrombosis (2). A Greenfield filter was eventually placed in 10 (50%) of the Group A patients without complications. Thirty percent (3/10) of the Group B patients developed progression of deep vein thrombosis that required anticoagulation. One other Group B patient died due to a guidewire-induced arrhythmia. Although patients with advanced cancers and venous thromboembolic disease have a high complication rate with either treatment, initial treatment with a Greenfield filter appears more definitive. Anticoagulation should be reserved for patients with progressive, symptomatic deep vein thromboses after placement of a filter.
Calligaro
K D
KD
Department of Medicine, Pennsylvania Hospital/University of Pennsylvania School of Medicine, Philadelphia.
Bergen
W S
WS
Haut
M J
MJ
Savarese
R P
RP
DeLaurentis
D A
DA
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D011655:Pulmonary Embolism / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D013924:Thrombophlebitis / Q000150:complications / Q000628:therapy*; D016306:Vena Cava Filters
D000925:Anticoagulants