Cancer-associated superficial vein thrombosis: clinical outcomes and management

Venous thromboembolism (VTE) is a major cause of morbidity and noncancer mortality in patients with active malignancy, and management frameworks for cancer-associated deep vein thrombosis (DVT) and pulmonary embolism (PE) are well developed. In contrast, there exists controversy in the management of isolated superficial vein thrombosis (iSVT) in patients with active malignancies, as the guideline recommended treatment regimens for iSVT are based on randomized trials that largely excluded patients with active cancer, Furthermore, patients with cancer have a higher risk of bleeding and thrombosis complicating anticoagulant management. This review synthesizes evidence on outcomes and management of cancer-associated iSVT. The evidence indicates there is a high rate of subsequent VTE incidence after cancer-associated iSVT despite anticoagulation, and comparisons of patients with active malignancy to noncancer- associated iSVT demonstrated a substantially higher VTE risk with cancer, with low rates of major bleeding. This suggests that patients with cancer-associated iSVT may benefit from higher doses of anticoagulation and/or extended therapy. However, the data suffers from heterogeneity and limited numbers emphasizing the need for randomized controlled trials to assess the optimal anticoagulant intensity/duration for patients with cancer-associated iSVT.