Treatment of venous thromboembolism in cancer patients

Treatment of venous thromboembolism in cancer patients needs to be done early because the rate of venous thromboembolism is increasing and is the leading cause of death. In cancer treatment, it is also necessary to prevent and treat venous thrombosis to improve and increase the patient's chances and survival time.

Venous thromboembolism (VTE) is a complex and common complication of cancer, and is a major cause of death in cancer patients. Compared with patients with VTE without cancer, VTE complications in cancer patients have a higher recurrence rate and worse prognosis.

Venous thrombosis is a common complication in cancer patients. The following are factors that increase the risk of VTE in cancer patients:
Age: Elderly patient (>65 years old) Cancer type: Pancreatic cancer, Stomach cancer, Brain cancer , Lung Cancer , Colon Cancer , Kidney Cancer , Ovarian Cancer , Uterine Cancer , Blood Cancer . Cancer progression: Metastatic cancer, an advanced stage of the disease. Active cancer treatment with chemotherapy. Cancer patients were treated with surgical methods. Values ​​of white blood cells and red blood cells.

Venous thrombosis in cancer patients is a disease with acute manifestations:
Deep vein thrombosis: Based on risk factors, clinical symptoms with manifestations such as swelling and edema of the extremities lower, painful, red skin. Vascular ultrasound can clearly show thrombus. Superficial vein thrombosis: Based on risk factors, clinical symptoms with manifestations such as tension, swelling, pain, red skin. Vascular ultrasound can clearly show thrombus. Visceral venous thrombosis: Based on risk factors such as cancer patients treated with surgery, cancer location in the abdomen, pancreatitis, cirrhosis of the liver; clinical symptoms with manifestations such as abdominal pain, fever, diarrhea, hepatosplenomegaly, gastrointestinal bleeding, resistant shock. The diagnostic test technique is duplex ultrasound. Pulmonary embolism: Based on risk factors, clinical symptoms with manifestations such as dyspnea, chest pain, tachycardia. Diagnostic testing techniques are ECG measurement, echocardiography showing right ventricular dilatation, magnetic resonance imaging, contrast-enhanced pulmonary angiography.

Management of venous thrombosis in cancer patients is complicated because of the high risk of hemorrhagic complications and recurrence. In addition, cancer patients often have comorbidities such as kidney failure.
Treatment of venous thromboembolism in cancer patients according to current guidelines include:
Low molecular weight heparin (LMWH): In initial treatment, single LWMH has been shown to be more effective than UFH and helps reduce mortality. The recommended duration of LMWH use is a minimum of 3 to 6 months for patients with VTE with cancer, indefinitely for patients on active and ongoing cancer treatment. Besides, LMWH also has a higher therapeutic effect than Warfarin in reducing the risk of recurrent venous thrombosis in patients with pulmonary embolism, deep vein thrombosis. Unfractionated Heparin (UFH): UFH may be indicated in cancer patients with renal failure. Fondaparinux: Fondaparinux may be indicated for patients with heparin-induced thrombocytopenia (HIT). Direct Oral Anticoagulants (DOACs): Currently, DOACs are not recommended for the treatment of VTE in cancer patients due to lack of data. However, in which, Warfarin can be indicated as an alternative in cases where LMWH is contraindicated for a long time, or patients refuse to be treated with LMWH due to its high cost. Dosage of anticoagulants in the treatment of venous thrombosis in cancer patients is as follows:
Low molecular weight heparin (LMWH): Select acute treatment according to one of two regimens. Regimen 1 is using Enoxaparin 1mg/kg/2 times/day (12 hours apart), regimen 2 is using Enoxaparin 1.5mg/kg/time/day. Prophylactic treatment with a dose of Enoxaparin 40mg/time/day. Unfractionated Heparin (UFH): Acute treatment is by intravenous injection of 80 IU/kg, followed by 18 IU/kg/h. Prophylactic treatment with a dose of UFH 5000 UI/3 times/day. Direct Oral Anticoagulant (DOAC): Apixaban at 10 mg twice daily (for 7 days), followed by 5 mg twice daily. Rivaroxaban at a dose of 15 mg / 2 times / day (used for 21 days), followed by a dose of 20 mg / day.

The risk of venous thrombosis in cancer patients may occur at the following times:
Hospitalization for treatment of recurrent cancer After cancer surgery To prevent venous thrombosis in cancer patients A prevention strategy should be implemented that includes the following steps:
Step 1: Assess the risk of VTE on admission based on risk factors and clinical status. Step 2: Assess bleeding risk and contraindications to anticoagulation. Step 3: Select appropriate prevention measures and time. Step 4: Give the patient recommendations for venous thromboembolism prevention. Recommendations for VTE prevention in cancer patients are as follows:
Inpatient cancer treatment: Systemic prevention of VTE in bedridden cancer patients and no system for cancer patients with underground catheters, short-term chemotherapy or hormone therapy. Patients undergoing surgical cancer treatment: Depending on the type of surgery to provide systematic prevention of venous thrombosis in patients undergoing surgery for cancer treatment. Outpatient cancer treatment: Prophylaxis is not recommended for all outpatient cancer patients, however, venous thromboembolism prophylaxis is recommended for high-risk patients (patients with multiple sclerosis). marrow, pancreatic cancer, stomach cancer). In addition, based on the Khorana scale to assess the high risk level of the patient, thereby providing prevention.

Pressure elastic bandage (medical pressure socks): Indicated for early treatment for patients with deep vein thrombosis and maintained for at least 2 years of treatment. Early mobilization: Encourage the patient to sit up and exercise early, after wearing medical pressure socks or applying pressure elastic bandages. Inject (directly or through catheter) systemic TSH (or direct through): indicated for patients with acute massive thrombosis in the pelvis - femoral region, or at risk of arterial compression causing limb necrosis. or patients with a prognosis of more than 1 year with no contraindications. Inferior vena cava filter: Indicated for patients treated for proximal deep vein thrombosis, but contraindicated for anticoagulation, or patients with recurrent venous thrombosis. Thrombectomy: Indicated for patients with acute massive thrombosis in the iliac-femoral region, with a prognosis of more than 1 year of survival, or at risk of arterial compression causing limb necrosis. have contraindications. In cancer treatment, patients need to be prevented and treated for venous thrombosis because this is a dangerous complication, increasing the patient's mortality rate.
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