Venous thromboembolism (VTE)

All chronic disease leads to an increased risk of venous thromboembolism and is a common cause of hospital admission. D dimer measurements in this population are generally unhelpful and therefore radiological imaging in those with advanced disease processes is often required. 

Risk factors

• Cancer of any site, but especially those with pelvic involvement
• Recent chemotherapy
• Recent surgical procedures
• Immobility
• Cardiac, respiratory, or renal disease
• Thrombophilia
• Older age (>65 years)
• Hormonal medications
• Indwelling medical devices such as lines

Treatment

• While investigation for VTE treat with low molecular weight heparin (LMWH)
• Once confirmed either patient will continue LMWH, or will commence oral anticoagulation with warfarin or direct oral anticoagulant (DOAC)
• Choice of long-term anticoagulation will depend on prognosis, liver function, renal function and bleeding risk in each individual patient
• Patient risks and benefits must be regularly reassessed as there may come a point where burden of treatment is no longer beneficial