Abstract Number: PB0908
Meeting: ISTH 2022 Congress
Background: Oncology patients with major bleeding who later develop Venous Thromboembolism present a difficult therapeutic dilemma because of risk of recurrent fatal pulmonary embolism if untreated and life threatened hemorrhage if treated with anticoagulant.
Aims: To highlight challenges of managing coexisting bleeding and thrombosis in cancer as well as role of local hemostatic radiotherapy.
Methods: This is a case series of 4 patients with major bleeding and Cancer Associated Thrombosis.
Results: The first two patients are middle aged woman with advanced cervical cancer. They both presented with massive pulmonary embolism and bleeding per vagina requiring transfusion support. The patients were commenced on low molecular weight heparin (LMWH) for the treatment of PE and a local hemostatic mechanism like packing the vagina with adrenaline-soaked gauze was put in place. Despite this, the bleeding persisted. Although intravenous tranexamic acid reduced the bleeding but there are concerns on its procoagulant effect. The dose of anticoagulant was reduced in one and was completely withdrawn in another due to risk of exsanguination. They both had hemostatic radiotherapy to the cervix which significantly control the bleeding, and this allowed recommencement of anticoagulation. They both made significant improvement in their symptoms.
The other two patients were managed for prostate CA and anaplastic large cell lymphoma. They both had clinically significant bleeding and DVT. The later developed PE. In these two, anticoagulation was only possible after resolution of bleeding with hemostatic radiotherapy. One of them have recurrence of symptoms while the other eventually died of pulmonary embolism.
Conclusion(s): The cases reported above highlights the therapeutic dilemma of managing patient with VTE and major bleeding particularly in cancer settings. Challenges include deciding when to hold on with anticoagulation, appropriate choice of hemostatic treatment. Achieving hemostasis with radiotherapy in these patients allows use of appropriate anticoagulant in managing their VTE.
To cite this abstract in AMA style:Bolarinwa A, Popoola O, Elebute M. Bleeding versus thrombosis: Case series on dilemma of VTE management in cancer patients and role of radiotherapy [abstract]. https://abstracts.isth.org/abstract/bleeding-versus-thrombosis-case-series-on-dilemma-of-vte-management-in-cancer-patients-and-role-of-radiotherapy/. Accessed March 4, 2024.
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