Prevention and management of venous thromboembolism in the cancer patient

Venous thromboembolic disease is notably one of the leading causes of death in cancer patients and is a cause of significant morbidity and mortality. Malignancy-related physiologic abnormalities and certain anticancer therapies can lead to hypercoagulability. Critical illness also adds to the risk for venous thromboembolism in this cohort due to factors such as immobility and central venous catheters. Thus critically ill cancer patients are especially vulnerable to developing a venous thromboembolism, and a focus on prevention as well as clinical suspicion should be an initially high priority. Once a diagnosis is made, however, management of venous thromboembolism in oncology patients can be especially complex given the wide array of cardiac and pulmonary abnormalities that often coexist in this patient population, as well as the common contraindications that exist to standard therapy and anticoagulation. For critically ill patients with intermediate or high-risk pulmonary emboli, alternatives to anticoagulation or thrombolytic therapy need to be understood in the event that a contraindication such as severe thrombocytopenia or a high risk for bleeding exists.