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Semin intervent Radiol 2017; 34(01): 50-53
DOI: 10.1055/s-0036-1597763
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Deep Vein Thrombosis Interventions in Cancer Patients

Resmi Ann Charalel
1   Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
,
Suresh Vedantham
1   Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations
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Publication History

Publication Date:
02 March 2017 (online)

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Abstract

The presence of cancer increases the risk of deep vein thrombosis (DVT), DVT recurrence, and treatment-related bleeding, and therefore offers distinctive clinical considerations when planning treatment. Anticoagulation with a low-molecular-weight heparin is the preferred initial and long-term therapy in cancer patients. Inferior vena cava filters may be used judiciously for patients with cancer-related DVT who have contraindications to anticoagulation or who exhibit breakthrough pulmonary embolism (PE) despite anticoagulation, but should be removed when the PE risk is felt to subside. Because moderate-quality evidence suggests that the use of catheter-directed thrombolysis (CDT) can prevent the postthrombotic syndrome, cancer patients with acute iliofemoral DVT, low expected bleeding risk, and good functional status may reasonably be considered for CDT if DVT-related sequelae are likely to be a dominant contributor to the patient's clinical condition, functional status, and quality of life. In selected patients who have chronic venous symptoms from mass/nodal compression of the pelvic veins, endovascular stent placement may provide symptom relief. As current recommendations are based on very limited data, further studies would be welcome to better delineate the most appropriate use of endovascular therapies in patients with cancer.

Keywords

deep vein thrombosis - cancer - thrombolysis - anticoagulation - stent
 

  • References

  • 1 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (6) 809-815
    CrossrefPubMedGoogle Scholar
  • 2 Lee AY, Levine MN. Venous thromboembolism and cancer: risks and outcomes. Circulation 2003; 107 (23, Suppl 1): I17-I21
    PubMedGoogle Scholar
  • 3 Prandoni P, Lensing AW, Cogo A , et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 4 Carson JL, Kelley MA, Duff A , et al. The clinical course of pulmonary embolism. N Engl J Med 1992; 326 (19) 1240-1245
    CrossrefPubMedGoogle Scholar
  • 5 Falanga A, Rickles FR. Pathophysiology of the thrombophilic state in the cancer patient. Semin Thromb Hemost 1999; 25 (2) 173-182
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Mandalà M, Falanga A, Roila F ; ESMO Guidelines Working Group. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2011; 22 (22, Suppl 6): vi85-vi92
    CrossrefPubMedGoogle Scholar
  • 7 Streiff MB ; National Comprehensive Cancer Center Network. The National Comprehensive Cancer Center Network (NCCN) guidelines on the management of venous thromboembolism in cancer patients. Thromb Res 2010; 125 (Suppl. 02) S128-S133
    CrossrefPubMedGoogle Scholar
  • 8 Kearon C, Akl EA, Ornelas J , et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (2) 315-352
    CrossrefPubMedGoogle Scholar
  • 9 Carrier M, Cameron C, Delluc A, Castellucci L, Khorana AA, Lee AY. Efficacy and safety of anticoagulant therapy for the treatment of acute cancer-associated thrombosis: a systematic review and meta-analysis. Thromb Res 2014; 134 (6) 1214-1219
    CrossrefPubMedGoogle Scholar
  • 10 Prandoni P, Lensing AW, Piccioli A , et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedGoogle Scholar
  • 11 Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev 2014; 1 (1) CD002783
    PubMedGoogle Scholar
  • 12 Grewal NK, Martinez JT, Andrews L, Comerota AJ. Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with postthrombotic morbidity. J Vasc Surg 2010; 51 (5) 1209-1214
    CrossrefPubMedGoogle Scholar
  • 13 Comerota AJ, Grewal N, Martinez JT , et al. Postthrombotic morbidity correlates with residual thrombus following catheter-directed thrombolysis for iliofemoral deep vein thrombosis. J Vasc Surg 2012; 55 (3) 768-773
    CrossrefPubMedGoogle Scholar
  • 14 Utne KK, Tavoly M, Wik HS , et al. Health-related quality of life after deep vein thrombosis. Springerplus 2016; 5 (1) 1278
    CrossrefPubMedGoogle Scholar
  • 15 Haig Y, Enden T, Grøtta O , et al; CaVenT Study Group. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 2016; 3 (2) e64-e71
    PubMedGoogle Scholar
  • 16 Bjarnason H, Kruse JR, Asinger DA , et al. Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. J Vasc Interv Radiol 1997; 8 (3) 405-418
    CrossrefPubMedGoogle Scholar
  • 17 Brailovsky Y, Lakhter V, Zack C, Gaughan J, Bove A, Bashir R. Comparative outcomes of catheter-directed thrombolysis with anticoagulation versus anticoagulation alone in cancer patients with deep venous thrombosis. J Am Coll Cardiol 2013; 61 (10_S): E2073
    CrossrefPubMedGoogle Scholar
  • 18 Kim HS, Preece SR, Black JH, Pham LD, Streiff MB. Safety of catheter-directed thrombolysis for deep venous thrombosis in cancer patients. J Vasc Surg 2008; 47 (2) 388-394
    CrossrefPubMedGoogle Scholar
  • 19 Lee AY, Peterson EA. Treatment of cancer-associated thrombosis. Blood 2013; 122 (14) 2310-2317
    CrossrefPubMedGoogle Scholar
  • 20 Vedantham S, Sista AK, Klein SJ , et al; Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe Standards of Practice Committees. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 2014; 25 (9) 1317-1325
    CrossrefPubMedGoogle Scholar
  • 21 Delis KT, Bjarnason H, Wennberg PW, Rooke TW, Gloviczki P. Successful iliac vein and inferior vena cava stenting ameliorates venous claudication and improves venous outflow, calf muscle pump function, and clinical status in post-thrombotic syndrome. Ann Surg 2007; 245 (1) 130-139
    CrossrefPubMedGoogle Scholar
  • 22 Elting LS, Escalante CP, Cooksley C , et al. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med 2004; 164 (15) 1653-1661
    CrossrefPubMedGoogle Scholar
  • 23 U.S. Food and Drug Administration. Removing Retrievable Inferior Vena Cava Filters: Initial Communication. 2010 ; Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm . Accessed August 23, 2016
    PubMedGoogle Scholar
  • 24 U.S. Food and Drug Administration. Removing Retrievable Inferior Vena Cava Filters: FDA Safety Communication. 2014 ; Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm . Accessed August 23, 2016
    PubMedGoogle Scholar
  • 25 Kahn SR, Shrier I, Julian JA , et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149 (10) 698-707
    CrossrefPubMedGoogle Scholar
  • 26 Palareti G, Legnani C, Lee A , et al. A comparison of the safety and efficacy of oral anticoagulation for the treatment of venous thromboembolic disease in patients with or without malignancy. Thromb Haemost 2000; 84 (5) 805-810
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Napolitano M, Saccullo G, Malato A , et al. Optimal duration of low molecular weight heparin for the treatment of cancer-related deep vein thrombosis: the Cancer-DACUS Study. J Clin Oncol 2014; 32 (32) 3607-3612
    CrossrefPubMedGoogle Scholar
  • 28 Kahn SR, Galanaud JP, Vedantham S, Ginsberg JS. Guidance for the prevention and treatment of the post-thrombotic syndrome. J Thromb Thrombolysis 2016; 41 (1) 144-153
    CrossrefPubMedGoogle Scholar
  • 29 Kahn SR. How I treat postthrombotic syndrome. Blood 2009; 114 (21) 4624-4631
    CrossrefPubMedGoogle Scholar
  • 30 Kahn SR, Shbaklo H, Lamping DL , et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 2008; 6 (7) 1105-1112
    CrossrefPubMedGoogle Scholar