Trousseau Syndrome: Management of Refractory VTE

Overview

Journal Hematology Am Soc Hematol Educ Program

Specialty Hematology

Date 2024 Dec 7

PMID 39644033

Authors

Jeffrey I Zwicker

Affiliations

Soon will be listed here.

Abstract

Managing recurrent and refractory venous thromboembolism (VTE) in patients with cancer presents unique challenges. This review outlines the complexities and therapeutic strategies for recurrent VTE in cancer patients, which includes distinguishing thrombus acuity, differentiating between tumor and bland thrombi, and evaluating potential contributing factors including anticoagulant adherence, extrinsic tumor compression, drug interactions, and anticoagulant-specific considerations such as heparin-induced thrombocytopenia or antithrombin deficiency. Different anticoagulation strategies are discussed, including the administration of escalated-dose low molecular weight heparin (LMWH) as well as the indications and rationale for switching between direct oral anticoagulants or LMWH.

References

Prandoni P, Lensing A, Prins M, Bernardi E, Marchiori A, Bagatella P . Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med. 2002; 137(12):955-60. DOI: 10.7326/0003-4819-137-12-200212170-00008. View

Croles F, Lukens M, Mulder R, de Maat M, Mulder A, Meijer K . Monitoring of heparins in antithrombin-deficient patients. Thromb Res. 2019; 175:8-12. DOI: 10.1016/j.thromres.2019.01.007. View

Tan M, Mol G, van Rooden C, Klok F, Westerbeek R, Sol A . Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis. Blood. 2014; 124(4):623-7. DOI: 10.1182/blood-2014-04-566380. View

Needleman L, Cronan J, Lilly M, Merli G, Adhikari S, Hertzberg B . Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018; 137(14):1505-1515. DOI: 10.1161/CIRCULATIONAHA.117.030687. View

Sarswat S, Khan D, Sagar S, Kumar R . Role of 18 F-FDG PET/CT in the diagnosis of benign vs. malignant tumor thrombus. Nucl Med Commun. 2023; 44(8):726-731. DOI: 10.1097/MNM.0000000000001708. View

Acton E, Hennessy S, Gelfand M, Leonard C, Bilker W, Shu D . Direct-Acting Oral Anticoagulants and Antiseizure Medications for Atrial Fibrillation and Epilepsy and Risk of Thromboembolic Events. JAMA Neurol. 2024; 81(8):835-844. PMC: 11231911. DOI: 10.1001/jamaneurol.2024.2057. View

Martin K, Beyer-Westendorf J, Davidson B, Huisman M, Sandset P, Moll S . Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: Updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation. J Thromb Haemost. 2021; 19(8):1874-1882. DOI: 10.1111/jth.15358. View

Schaefer J, Li M, Wu Z, Basu T, Dorsch M, Barnes G . Anticoagulant medication adherence for cancer-associated thrombosis: A comparison of LMWH to DOACs. J Thromb Haemost. 2020; 19(1):212-220. DOI: 10.1111/jth.15153. View

Rana M, Rahman O, OBrien A . Primary pulmonary angiosarcoma. BMJ Case Rep. 2021; 14(11). PMC: 8578948. DOI: 10.1136/bcr-2021-244578. View

10.

Ortel T, Neumann I, Ageno W, Beyth R, Clark N, Cuker A . American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020; 4(19):4693-4738. PMC: 7556153. DOI: 10.1182/bloodadvances.2020001830. View

11.

Lee A, Levine M, Baker R, Bowden C, Kakkar A, Prins M . Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003; 349(2):146-53. DOI: 10.1056/NEJMoa025313. View

12.

Young A, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C . Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol. 2018; 36(20):2017-2023. DOI: 10.1200/JCO.2018.78.8034. View

13.

Pei X, Lu M, Liu Z, Liu B, Deng Y, Yuan H . The value of enhanced multiparameteric MRI diagnostic model for preoperatively predicting surgical methods of inferior vena cava in patients with renal tumors and inferior vena cava tumor thrombus. BMC Med Imaging. 2023; 23(1):86. PMC: 10290788. DOI: 10.1186/s12880-023-01043-0. View

14.

Perlman A, Wanounou M, Goldstein R, Choshen Cohen L, Singer D, Muszkat M . Ischemic and Thrombotic Events Associated with Concomitant Xa-inhibiting Direct Oral Anticoagulants and Antiepileptic Drugs: Analysis of the FDA Adverse Event Reporting System (FAERS). CNS Drugs. 2019; 33(12):1223-1228. DOI: 10.1007/s40263-019-00677-5. View

15.

Pouncey A, Kahn T, Morris R, Saha P, Thulasidasan N, Black S . Risk factors and classification of reintervention following deep venous stenting for acute iliofemoral deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2022; 10(5):1051-1058.e3. DOI: 10.1016/j.jvsv.2022.03.006. View

16.

Gupta A, Shah U, Khine H, Vandergriff T, Froehlich T . Antiphospholipid syndrome associated with combined immune checkpoint inhibitor therapy. Melanoma Res. 2017; 27(2):171-173. DOI: 10.1097/CMR.0000000000000335. View

17.

Kaptein F, van der Hulle T, Braken S, van Gennep E, Buijs J, Burgmans M . Prevalence, Treatment, and Prognosis of Tumor Thrombi in Renal Cell Carcinoma. JACC CardioOncol. 2022; 4(4):522-531. PMC: 9700252. DOI: 10.1016/j.jaccao.2022.07.011. View

18.

Ip B, Ko H, Wong G, Yip T, Lau L, Lau A . Thromboembolic Risks with Concurrent Direct Oral Anticoagulants and Antiseizure Medications: A Population-Based Analysis. CNS Drugs. 2022; 36(12):1313-1324. PMC: 9712286. DOI: 10.1007/s40263-022-00971-9. View

19.

Kaufman L, Yeh B, Breiman R, Joe B, Qayyum A, Coakley F . Inferior vena cava filling defects on CT and MRI. AJR Am J Roentgenol. 2005; 185(3):717-26. DOI: 10.2214/ajr.185.3.01850717. View

20.

Kumar R, Bhandari S, Singh S, Malapati S, Cisak K . Incidence and outcomes of heparin-induced thrombocytopenia in solid malignancy: an analysis of the National Inpatient Sample Database. Br J Haematol. 2020; 189(3):543-550. DOI: 10.1111/bjh.16400. View