| Peer-Reviewed

Use of Anti-coagulants in Cancer Patients with Superficial Thrombophlebitis to Prevent Pulmonary Embolism

Received: 20 September 2020     Accepted: 12 July 2021     Published: 21 July 2021
Views:       Downloads:
Abstract

Superficial thrombophlebitis (STP) is an inflammation of superficial veins with associated venous thrombosis. It is a benign condition usually and can be managed with a conservative approach with non-steroidal anti-inflammatory drugs (NSAIDs) and warm compression. When STP is associated with high-risk medical conditions such as cancer and chemotherapy, fatal complications such as pulmonary embolism (PE) and deep venous thrombosis (DVT) may ensue. The severity of thromboembolic complications of STP as well as the multiple common risk factors between DVT and STP has led to further research interest in exploring the efficacy of anticoagulation treatment in DVT and STP. Traditionally, low molecular weight heparin (LMWH) and warfarin have been used for the treatment of venous thromboembolism (VTE), but recently direct oral Anticoagulants (DOACs) have emerged as a potential alternative considering better or equivalent efficacy, safety, and ease of use compared to LMWH and warfarin. A few case reports have described the advancement of STP to PE in cancer patients while on chemotherapy. We report a case of a 56-year old female with colon cancer on chemotherapy who developed PE after two episodes of STP. We recommend that when cancer patients on chemotherapy develop STP, prophylactic use of anti-coagulants should be considered to reduce the risk of serious complications.

Published in World Journal of Medical Case Reports (Volume 2, Issue 3)
DOI 10.11648/j.wjmcr.20210203.12
Page(s) 35-40
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Superficial Thrombophlebitis, Pulmonary Embolism, Chemotherapy, Cancer, Anticoagulant

References
[1] Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2018 Feb 25; 2: CD004982.
[2] Schonauer V, Kyrle PA, Weltermann A, Minar E, Bialonczyk C, Hirschi M, et al. Superficial thrombophlebitis and risk for recurrent venous thromboembolism. J Vasc Surg 2003 Apr; 37 (4): 834e8.
[3] Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. 1973; 48 (4): 839-46. http://dx.doi.org/10.1161/01.CIR.48.4.839. PMID: 4744789.
[4] Décousus H, Bertoletti L, Frappé P. Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat? J Thromb Haemost. 2015 Jun; 13 Suppl 1: S230-7.
[5] Scott G, Mahdi AJ, Alikhan R. Superficial vein thrombosis: a current approach to management. Br J Haematol. 2015 Mar; 168 (5): 639-45.
[6] Markovic MD, Lotina SI, Davidovic LB, et al. Acute superficial thrombophlebitis: modern diagnosis and therapy. Srp Arch Celok Lek 1997; 125: 261-6.
[7] Vekaria, Pratikkumar MD; Raiyani, Chandrika MD; Robitshek, Daniel MD; Raiyani, Tejas MD 3074 In Colon Cancer: Superficial Thrombophlebitis Is a Road to PE, The American Journal of Gastroenterology: October 2019 - Volume 114 - Issue - p S1654-S1655 doi: 10.14309/01.ajg.0000601828.04642.2b.
[8] Verlato F, Zucchetta P, Prandoni P, et al. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg 1999; 30: 1113-15.
[9] Wilbur J, Shian B. Diagnosis of deep venous thrombosis and pulmonary embolism. Am Fam Physician. 2012; 86 (10): 913–919.
[10] Bounameaux H, Reber-Wasem MA. Superficial thrombophlebitis and deep vein thrombosis: a controversial association. Arch Intern Med 1997; 157: 1822.
[11] Caine GJ, Stonelake PS, Lip GY, Kehoe ST. The Hypercoagulable State of Malignancy: Pathogenesis and Current Debate. Neoplasia (New York, NY). 2002; 4 (6): 465-473.
[12] Varki A. Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood. 2007; 110 (6): 1723–1729.
[13] Dickson B. C. Venous thrombosis: On the history of Virchow’s triad. Univ. Tor. Med. J. 2004; 81: 166–171.
[14] Sobreira ML, Yoshida WB, Lastória S. Tromboflebite superficial: epidemiologia, fisiopatologia, diagnóstico e tratamento. J Vasc Bras. 2008; 7 (2): 131-43.
[15] Ascer E, Loresen E, Pollina RM, Gennaro M. Preliminary results of a non-operative approach to saphena femoral junction thrombophlebitis. J Vasc Surg, 22 (1995), pp. 616-621.
[16] Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J. Occult deep vein thrombosis complicating superficial thrombophlebitis. J Vasc Surg 1998; 27: 338-43.
[17] Frederick R. Rickles, Mark Levine, Richard L. Edwards. Hemostatic alterations in cancer patients. Cancer and Metastasis Reviews, 1992, Volume 11, Number 3-4, Page 237.
[18] Jorgensen JO, Hanel KC, Morgan AM, Hunt JM. The incidence of deep vein thrombosis in patients with superficial thrombophlebitis of the lower limbs. J Vasc Surg 1993; 18: 70.
[19] Decousus H, Epinat M, Guillot K, Quenet S, Boissier C, Tardy B. Superficial vein thrombosis: risk factors, diagnosis, and treatment. Curr Opin Pulm Med. 2003; 9 (5): 393-7.
[20] Leizorovicz A, Becker F, Buchmuller A, Quéré I, Prandoni P, Decousus H. Clinical relevance of symptomatic superficial-vein thrombosis extension: lessons from the CALISTO study. Blood. 2013; 122 (10): 1724-9.
[21] Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015 Jun 22; 350: h2039.
[22] Tait C, Baglin T, Watson H, Laffan M, Makris M, Perry D, Keeling D., British Committee for Standards in Haematology. Guidelines on the investigation and management of venous thrombosis at unusual sites. Br J Haematol. 2012 Oct; 159 (1): 28-38.
[23] Khorana, A. A., Kuderer, N. M., Culakova, E., Lyman, G. H., Francis, C. W. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood, 2008; 111 (10), 4902-4907.
[24] Wichers IM, Di Nisio M, Buller HR, Middeldorp S. Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review. Haematologica. 2005; 90 (5): 672-7.
[25] Leon L, Giannoukas AD, Dodd D, Chan P, Labropoulos N. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg. 2005; 29 (1): 10-7.
[26] Milio G, Siragusa S, Mina C, et al. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins. Thromb Res. 2008; 123 (2): 194-9.
[27] Decousus H, Quere I, Presles E, et al. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010; 152 (4): 218-24.
[28] Mouton WG, Kienle Y, Muggli B, Naef M, Wagner HE. Tumors associated with supercial thrombophlebitis. Vasa 2009; 38: 167-70.20.
[29] Prandoni P. Antithrombotic strategies in patients with cancer. Thromb Haemost. 1997; 78: 141–144.
[30] Kakkar AK, Williamson RCN. Prevention of venous thromboembolism in cancer patients. Semin Thromb Haemost. 1999; 25: 239–243.
[31] Donati MB. Cancer and thrombosis: from phlegmasia alba dolens to transgenic mice. Thromb Haemost. 1995; 74: 278–281.
[32] Dvorak HF. Abnormalities of haemostasis in malignant disease. In: Colman W, Hirsh J, Marder VJ, Salzman EW, editors. Haemostasis and Thrombosis. 3rd edn. Philadelphia, PA: Lippincott; 1994. pp. 1238–1254.
[33] Luzzato G, Schafer AI. The prethrombotic state in cancer. Semin Oncol. 1990; 17: 147–158.
[34] Levine MN. Prevention of thrombotic disorders in cancer patients undergoing chemotherapy. Thromb Haemost. 1997; 78: 133–136.
[35] Lee AYY, Levine MN. The thrombophilic state induced by therapeutic agents in cancer patients. Semin Thromb Haemost. 1999; 25: 137–145.
[36] Bona R. Thrombotic complications of central venous catheters in cancer patients. Semin Thromb Haemost. 1999; 25: 147–155.
[37] Gallus AS. Prevention of post-operative deep leg vein thrombosis in patients with cancer. Thromb Haemost. 1997; 78: 126–132.
[38] Nasser N. J., Na’amad M., Weinberg I., Gabizon A. A. Pharmacokinetics of low molecular weight heparin in patients with malignant tumors. Anti-Cancer Drugs. 2015; 26: 106–111. doi: 10.1097/CAD.0000000000000176.
[39] Lyman GH, Khorana AA, Kuderer NM, et al; American Society of Clinical Oncology Clinical Practice. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013; 31 (17): 2189-2204.
[40] Streiff MB, Holmstrom B, Ashrani A, et al. Cancer-associated venous thromboembolic disease, version 1.2015. J Natl Compr Canc Netw. 2015; 13 (9): 1079-1095.
[41] Lee A. Y., Levine M. N., Baker R. I., Bowden C., Kakkar A. K., Prins M., Rickles F. R., Julian J. A., Haley S., Kovacs M. J., et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N. Engl. J. Med. 2003; 349: 146–153. doi: 10.1056/NEJMoa025313.
[42] Kakkar A. K., Levine M. N., Kadziola Z., Lemoine N. R., Low V., Patel H. K., Rustin G., Thomas M., Quigley M., Williamson R. C. Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: The fragmin advanced malignancy outcome study (FAMOUS) J. Clin. Oncol. 2004; 22: 1944–1948. doi: 10.1200/JCO.2004.10.002.
[43] Kearon C, Akl EA, Comerota AJ, et al; American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141 (suppl 2): e419S-e494S.
[44] Lebeau B., Chastang C., Brechot J. M., Capron F., Dautzenberg B., Delaisements C., Mornet M., Brun J., Hurdebourcq J. P., Lemarie E. Subcutaneous heparin treatment increases survival in small cell lung cancer. Cancer. 1994; 74: 38–45. doi: 10.1002/1097-0142(19940701)74: 1<38: AID-CNCR2820740108>3.0.CO; 2-E.
[45] Lazo-Langner A., Goss G., Spaans J., Rodger M. The effect of low-molecular-weight heparin on cancer survival. A systematic review and meta-analysis of randomized trials. J. Thromb. Haemost. 2007; 5: 729–737. doi: 10.1111/j.1538-7836.2007.02427.x.
[46] Vekaria, Pratikkumar MD; Raiyani, Chandrika MD; Robitshek, Daniel MD; Raiyani, Tejas MD 1374 Pancreatic Cancer: Leading to Failure of Rivaroxaban as an Anticoagulant, The American Journal of Gastroenterology: October 2019 - Volume 114 - Issue - p S760-S761. doi: 10.14309/01.ajg.0000595024.63908.44.
[47] Song AB, Rosovsky RP, Connors JM, Al-Samkari H. Direct oral anticoagulants for treatment and prevention of venous thromboembolism in cancer patients. Vasc Health Risk Manag. 2019 Jun 21; 15: 175-186. doi: 10.2147/VHRM.S132556. PMID: 31417269; PMCID: PMC6593743.
[48] Christine G. Kohn, Gary H. Lyman, Jan Beyer-Westendorf, Alex C. Spyropoulos, Thomas J. Bunz and Craig I. Coleman. Effectiveness and Safety of Rivaroxaban in Patients with Cancer-Associated Venous Thromboembolism. Blood, 2017; 130: 3717.
[49] Giustozzi M, Agnelli G, Del Toro-Cervera J, Klok FA, Rosovsky RP, Martin AC, Herold J, Tzoran I, Szmit S, Bertoletti L, Becattini C, Huisman MV. Direct Oral Anticoagulants for the Treatment of Acute Venous Thromboembolism Associated with Cancer: A Systematic Review and Meta-Analysis. Thromb Haemost. 2020 Jul; 120 (7): 1128-1136. doi: 10.1055/s-0040-1712098. Epub 2020 May 4. PMID: 32365386.
[50] Yang M, Li J, Sun R, Wang Y, Xu H, Yang B, Wu X, Yu L. Comparison between direct factor Xa inhibitors and low-molecular-weight heparin for efficacy and safety in the treatment of cancer-associated venous thromboembolism: A meta-analysis. J Cancer Res Ther. 2019; 15 (7): 1541-1546. doi: 10.4103/jcrt.JCRT_68_19. PMID: 31939435.
[51] Brunetti ND, Tricarico L, Correale M, De Gennaro L, Santoro F, Ieva R, Di Biase M. Direct oral anticoagulants more effective than low-molecular-weight heparin for venous thrombo-embolism in cancer: an updated meta-analysis of randomized trials. J Thromb Thrombolysis. 2020 Aug; 50 (2): 305-310. doi: 10.1007/s11239-019-01974-y. PMID: 31654194.
[52] Agnelli G, Gussoni G, Bianchini C et al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: A randomised, placebo-controlled, double-blind study. Lancet Oncol 2009; 10: 943– 949.
[53] Carrier M, Abou-Nassar K, Mallick R et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 2019; 380: 711– 719.
[54] Khorana AA, Soff GA, Kakkar AK et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med 2019; 380: 720– 728.
Cite This Article
  • APA Style

    Pratikkumar Vekaria, Mansi Satasia, Tejas Raiyani, Rekha Rao, Chandrika Raiyani, et al. (2021). Use of Anti-coagulants in Cancer Patients with Superficial Thrombophlebitis to Prevent Pulmonary Embolism. World Journal of Medical Case Reports, 2(3), 35-40. https://doi.org/10.11648/j.wjmcr.20210203.12

    Copy | Download

    ACS Style

    Pratikkumar Vekaria; Mansi Satasia; Tejas Raiyani; Rekha Rao; Chandrika Raiyani, et al. Use of Anti-coagulants in Cancer Patients with Superficial Thrombophlebitis to Prevent Pulmonary Embolism. World J. Med. Case Rep. 2021, 2(3), 35-40. doi: 10.11648/j.wjmcr.20210203.12

    Copy | Download

    AMA Style

    Pratikkumar Vekaria, Mansi Satasia, Tejas Raiyani, Rekha Rao, Chandrika Raiyani, et al. Use of Anti-coagulants in Cancer Patients with Superficial Thrombophlebitis to Prevent Pulmonary Embolism. World J Med Case Rep. 2021;2(3):35-40. doi: 10.11648/j.wjmcr.20210203.12

    Copy | Download

  • @article{10.11648/j.wjmcr.20210203.12,
      author = {Pratikkumar Vekaria and Mansi Satasia and Tejas Raiyani and Rekha Rao and Chandrika Raiyani and Kevin Dan Phillips},
      title = {Use of Anti-coagulants in Cancer Patients with Superficial Thrombophlebitis to Prevent Pulmonary Embolism},
      journal = {World Journal of Medical Case Reports},
      volume = {2},
      number = {3},
      pages = {35-40},
      doi = {10.11648/j.wjmcr.20210203.12},
      url = {https://doi.org/10.11648/j.wjmcr.20210203.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20210203.12},
      abstract = {Superficial thrombophlebitis (STP) is an inflammation of superficial veins with associated venous thrombosis. It is a benign condition usually and can be managed with a conservative approach with non-steroidal anti-inflammatory drugs (NSAIDs) and warm compression. When STP is associated with high-risk medical conditions such as cancer and chemotherapy, fatal complications such as pulmonary embolism (PE) and deep venous thrombosis (DVT) may ensue. The severity of thromboembolic complications of STP as well as the multiple common risk factors between DVT and STP has led to further research interest in exploring the efficacy of anticoagulation treatment in DVT and STP. Traditionally, low molecular weight heparin (LMWH) and warfarin have been used for the treatment of venous thromboembolism (VTE), but recently direct oral Anticoagulants (DOACs) have emerged as a potential alternative considering better or equivalent efficacy, safety, and ease of use compared to LMWH and warfarin. A few case reports have described the advancement of STP to PE in cancer patients while on chemotherapy. We report a case of a 56-year old female with colon cancer on chemotherapy who developed PE after two episodes of STP. We recommend that when cancer patients on chemotherapy develop STP, prophylactic use of anti-coagulants should be considered to reduce the risk of serious complications.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Use of Anti-coagulants in Cancer Patients with Superficial Thrombophlebitis to Prevent Pulmonary Embolism
    AU  - Pratikkumar Vekaria
    AU  - Mansi Satasia
    AU  - Tejas Raiyani
    AU  - Rekha Rao
    AU  - Chandrika Raiyani
    AU  - Kevin Dan Phillips
    Y1  - 2021/07/21
    PY  - 2021
    N1  - https://doi.org/10.11648/j.wjmcr.20210203.12
    DO  - 10.11648/j.wjmcr.20210203.12
    T2  - World Journal of Medical Case Reports
    JF  - World Journal of Medical Case Reports
    JO  - World Journal of Medical Case Reports
    SP  - 35
    EP  - 40
    PB  - Science Publishing Group
    SN  - 2994-726X
    UR  - https://doi.org/10.11648/j.wjmcr.20210203.12
    AB  - Superficial thrombophlebitis (STP) is an inflammation of superficial veins with associated venous thrombosis. It is a benign condition usually and can be managed with a conservative approach with non-steroidal anti-inflammatory drugs (NSAIDs) and warm compression. When STP is associated with high-risk medical conditions such as cancer and chemotherapy, fatal complications such as pulmonary embolism (PE) and deep venous thrombosis (DVT) may ensue. The severity of thromboembolic complications of STP as well as the multiple common risk factors between DVT and STP has led to further research interest in exploring the efficacy of anticoagulation treatment in DVT and STP. Traditionally, low molecular weight heparin (LMWH) and warfarin have been used for the treatment of venous thromboembolism (VTE), but recently direct oral Anticoagulants (DOACs) have emerged as a potential alternative considering better or equivalent efficacy, safety, and ease of use compared to LMWH and warfarin. A few case reports have described the advancement of STP to PE in cancer patients while on chemotherapy. We report a case of a 56-year old female with colon cancer on chemotherapy who developed PE after two episodes of STP. We recommend that when cancer patients on chemotherapy develop STP, prophylactic use of anti-coagulants should be considered to reduce the risk of serious complications.
    VL  - 2
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Redmond Regional Medical Center, Rome, United States

  • Department of Dermatology, Byramjee Jeejabhoy Medical College, Ahmedabad, India

  • Redmond Regional Medical Center, Rome, United States

  • Frederick National Laboratory for Cancer Research, Frederick, United States

  • Redmond Regional Medical Center, Rome, United States

  • Redmond Regional Medical Center, Rome, United States

  • Sections