Managing cancer patients with acute venous thromboembolism: exploring safe alternatives to hospitalisation.
Acute venous thromboembolism (VTE) is a common and potentially fatal complication that frequently occurs in cancer patients. Few data are currently available about the optimal management of this category of high-risk patients. In clinical practice, physicians have to deal with many problems related to cancer patients with acute VTE. For instance, cancer patients with deep vein thrombosis (DVT) are frequently admitted to the hospital since their high rate of recurrent thrombotic events and/or bleeding-related therapy; however, most of them would prefer alternatives to prolonged hospitalisation. Then, it is not clearly whether data coming from a non-cancer population (such as that regarding the use of D-dimer test and/or pre-test clinical probability [PCP]), can be reliable applied in cancer patients. Finally, scanty information is present on the feasibility of the "home-treatment program" for DVT in this category of high-risk patients. In our review we present data on a population of cancer patients evaluated at the Emergency Care in whom we have evaluated: 1) the diagnostic accuracy of PCP and D-dimer test; 2) the safety and efficacy of low molecular weight heparins (LMWH) as "protective anticoagulation" in case of deferred imaging for VTE and 3) the safety and efficacy of home treatment.
Siragusa
Sergio
S
Chair of Hematology, University of Palermo, Palermo, Italy. trombosipalermo@tiscali.it.
Anastasio
Raffaela
R
Giarratano
Antonino
A
Malato
Alessandro
A
Bonifacio
Gaetano
G
Arcara
Carlo
C
Gebbia
Nicola
N
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006701:Home Nursing; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D012646:Self Administration; D012648:Self Care; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology
D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D