Authors: Chapter 2: Thromboembolic events and cancer (Jennifer Foglietta, Stefania Gori, Lucia Stocchi and Lucio Crinò)
Abstract: A venous thromboembolism is a common complication in patients with cancer, and it is associated with high morbidity, mortality, medical care and costs. Classical clinical symptoms of DVT are: pain, unilateral edema and heaviness in the distal extremity to the site of the venous thrombosis or edema in the face, neck or supraclavicular space. These signs and symptoms are not present in all cases so the diagnosis of DVT and PE made on clinical ground alone is notoriously unreliable. A clinical suspicion for VTE requires sensitive imaging studies such as a color duplex ultrasonography, spiral chest CT and ventilation-perfusion scan; in some cases, CT or MR venography could be useful. VTE risk factors in cancer patients are related to the type and stage of tumors, to the characteristics of patients (age, familial or acquired hypercoagulability,
medical comorbidities, performance status) and to the treatment (surgery, chemotherapy, endocrine therapy, insertion of central venous catheter). Modifiable risk factors are obesity, smoking history and exercise. Currently available drugs for preventing and treatingVTE are vitamin K antagonists (VKA), unfractioned heparin (UFH) and low molecular weight heparins (LMWHs). New antithrombotic agents, such as oral IIa and Xa inhibitors, could be useful, but further studies are needed.