Cardiology Research and Practice

Review Article

Saddle Pulmonary Embolism in a Cancer Patient with Thrombocytopenia: A Treatment Dilemma

Table 1

Summary of guidelines for treatment of VTE in cancer [11–15].


Condition	ASCO	NCCN	AIOM/ESMO	ACCP

Initial treatment (acute phase)	- 5–10 days = LMWH preferred	- LMWH, UFH (IV), FXa-I according to clinical situation	- LMWH, UFH (IV) For CrCl less than 25–30 mL/min, either LMWH, UFH with antiXa monitoring	- LMWH or VKA for minimum of 90 days
Long-term treatment (chronic phase)	- LMWH for 180 days - If LMWH not available then VKA - indefinite in active disease	- LMWH preferred - Indefinite in patients with active and persistent RF - DVT for 3–6 months - PE for 6–12 months	- LMWH for 90–180 days - Long-term for patients with active cancer	- LMWH or VKA for as long as cancer active
Thrombolytic for initial treatment	Only in limb-threatening thrombosis	Massive DVT or PE with hemodynamic instability	NA	NA
IVCF	- Presence of CI - Recurrent VTE despite AC	- Presence of CI - New PE that might be life-threatening of PHTN	- Presence of CI - Recurrent PE despite treatment	- In patients with acute PE, if anticoagulant is not possible due to high-risk of bleeding - As soon as risk of bleeding is minimal, AC should be started

VTE: venous thromboembolism; ASCO: American Society of Clinical Oncology; NCCN: National Comprehensive Cancer Network; AIOM: Italian Association of Medical Oncology; ESMO: European Society of Medical Oncology; ACCP: American College of Chest Physician; LMWH: low-molecular-weight-heparin; UFH: unfractionated heparin; FXa-I: factor- Xa inhibitor; VKA: vitamin K antagonist; RF: risk factors; DVT: deep-vein thrombosis; PE: pulmonary embolism; IVCF: inferior vena-caval filter; CI: contraindication; PHTN: pulmonary hypertension; AC: anticoagulation; IV: intravenous; NA: not addressed. CrCl: creatinine clearance.