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CC January 2016 Venous Thromboembolism and Cancer

rename
echoecho's version from 2016-02-09 13:57

Section

Question Answer
*** For patients with malignancy and normal renal function (creatinine clearance > 30 mL/min) and no contraindications to anticoagulation, initial treatment for themoboembolism with what is the treatment of choice?low-molecular-weight heparin (LMWH)
For long-term treatment, LMWH is the recommended treatment over what medication?vitamin K antagonists such as warfarin (Coumadin)
If the patient favors oral medication, what treatment is preferred over no treatment?vitamin K antagonists such as warfarin (Coumadin)
In the event of warfarin failure, the patient with thromboembolism and cancer should be switched to what medication?LMWH (enoxaparin) Lovenox
If a patient has recurrent venous thromboembolism (VTE) on LMWH, what should be done?the dose of thee LMWH should be adjusted (in one study, increasing the dose by 20-25% prevented additional VTE in 91% of patients at 3 months)
If a VTE recurred despite the dose increase, what dosing would be recommended?an additional increase or twice-daily dosing
An alternative is monitoring _____ levels and making LMWH dose adjustments based on resuljts, although evidence is laking to support this strategy?anti-Xa
What could be used if there is a contraindication to anticoagulation?IVC (inferior vena cava) filter
What are the benefits and disadvantages of using a IVC filter?1) it reduces the risk of puljmonary embolism 2) it DOUBLES the risk of recurrent venous thromobosis
Is there a mortality difference with IVC filter placement compared with anticoagulation?no
Limited data are available on the use of what anticoagulants in the setting of cancer and additional studies are needed before they are recommended with malignancy?target-specific oral anticoagulants (factor Xa inhibitors and direct thrombin inhibitors
What is known as risk factors for a first VTE in patients with malignancy?1) metastatic cancer 2) progressive cancer 3) chemotherapy (active cancer)
Are the above risk factors also true for recurrent VTE?yes
In patients with venous thromboembolism and active ancer, what is recommended over standard 3 month therapy?extended anticoagulant therapy
The benefit of therapy must be weighed against the risk of what?bleeding
Does anticoagulation offer any mortality benefit for cancer paitnets in the absence of a therapeutic or prophylactic indication?no
In the event of venous thromboembolism despite anticoagulation, patients should be assessed for what?medication adherence, antiphopholipid antibody syndrome, cancer 4) disseminated intravascular anticoagulation, heparin-induced thrombocytopenia, myeloproliferative disorders, antithrombin deficiency and structural defects
*** SUMMARY = For long-term treatment, what is recommended over vitamin K antagonists such as warfarin (Coumadin)?LWMH (low molecular-weight-heparin)
*** SUMMARY = If a patient has recurrent venous thromboembolism (VTE) on LMWH, the dose whould be what?adjusted
*** SUMMARY = If a VTE recurred despite the dose increase, then what is recommended?an additional increase or twice daily dosing
*** SUMMARY = Limited data are available on the use of what anticoagulants in the setting of cancer?target specific oral anticoagulants (factor Xa inhibitors and direct thormbin inhibitors)
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