Diagnosis and initial treatment of venous thromboembolism in patients with cancer.
OBJECTIVE
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.


CONCLUSIONS
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.
Streiff
Michael B
MB
Johns Hopkins Anticoagulation Service and Outpatient Clinics, Special Coagulation Laboratory, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. mstreif@jhmi.edu
D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D010690:Phlebography; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D053828:Stockings, Compression; D016019:Survival Analysis; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D016306:Vena Cava Filters / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*
D000925:Anticoagulants; D000970:Antineoplastic Agents