Deep Vein Thrombosis as a Complication of Gemcitabine-Capecitabine Chemotherapy in Adenocarcinoma of Gallbladder

Etha Dini Widiasi,1 Pradana Zaky Romadhon,1– 3 Ami Ashariati,1,3 Siprianus Ugroseno Yudho Bintoro,1,3 Muhammad Noor Diansyah,1– 3 Putu Niken Ayu Amrita,1,3 Merlyna Savitri1,3 1Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; 2Department of Internal Medicine, Universitas Airlangga Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; 3Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, IndonesiaCorrespondence: Pradana Zaky Romadhon, Department of Internal Medicine, Universitas Airlangga Hospital, Faculty of Medicine, Universitas Airlangga, Jalan Dharmahusada Permai, Mulyorejo, Surabaya, Jawa Timur, Indonesia, 60115, Email [email protected]: Gallbladder adenocarcinoma has a high mortality rate, with approximately 1.7% cancer-related deaths worldwide. Cancer-associated thrombosis (CAT), including deep vein thrombosis (DVT), can significantly increase the risk of mortality within cancer patients, especially in pancreatic, brain, and intra-abdominal cancers, as well as in advanced and metastatic cancers. In this case report, there was a 45-year-old male patient diagnosed with advanced gallbladder adenocarcinoma UICC stage IVB with a TNM stage of T2b, N0, M1 with liver metastases who experienced pain and swelling in both lower limbs after undergoing a VI-A cycle of chemotherapy with gemcitabine capecitabine. The risk of thrombosis was calculated using the modified Khorana-Vienna CAT scores, which increased during every chemotherapy session. In this case, the Khorana-Vienna CAT score was calculated during two latest cycle of chemotherapy that somewhat considered delayed as the patient had already shown hypercoagulopathy symptoms and developed a poorer prognosis. Early CAT scoring, ideally before starting chemotherapy session, potentially improves thrombosis prognosis. The patient’s condition improved after administration of antithrombotic agents. Chemotherapy agents and other factors, including the cancer site and presence of metastatic cancer, influence the risk of CAT. Risk predictor scores are required to assess the risk of CAT and benefits of prophylactic treatment. Prophylactic therapy can be initiated in patients with high-risk CAT, calculated using the modified Khorana and Vienna CAT scores, to prevent thrombosis and improve patient outcomes.Keywords: gallbladder cancer, deep vein thrombosis, cancer-associated thrombosis, Khorana-Vienna CAT score, chemotherapy, thromboprophylaxis