Cancer Associated Thrombosis: A Balancing Act

Background Cancer-associated thrombosis is a major health problem that affects morbidity and mortality of people with cancer, and is a leading cause of mortality after cancer itself, despite being a largely preventable disease. Surgical and systemic pharmacological anticancer treatments have a significant impact on thrombotic risk. Case History Male, 64 yo. entered ER due to severe anemia, worsening asthenia and melena. Gastroscopy was performed, detecting gastric cancer; during hospitalization, while waiting for histological typing, patient develops an episode of deep venous thrombosis complicated by threatened extremity (Phlegmasia Cerulea dolens), despite mechanical elastic compression (unstable Hb values did not allow starting pharmacological prophylaxis). In accordance with vascular radiology, patient underwent aspiration thrombectomy (Penumbra system): preprocedural clot burden was significant (involved cava, iliac and femoropopliteal left veins), but we obtained adequate clot clearance, resulted in great acute symptoms improvement. Discussion Risk of venous thromboembolism in patients with cancer is currently 12 times higher than in the general population, and even 23 times higher when they receive chemotherapy, but risk of thromboembolic events needs to be balanced with risk of bleeding events. Multidisciplinary therapeutic approach may provide therapeutic options in case of high bleeding risk and until oral anticoagulant therapy can be started.