Management of thrombosis in the cancer patient

The treatment of venous thromboembolism in the cancer patient presents many challenges. The safety and efficacy of anticoagulation in these patients are still evolving. The clinical scenario is often unique to each patient and dictates careful consideration of the method of anticoagulation. Various issues that need to be considered are the length of anticoagulation, the method of administration, and the potential pitfalls of initiating one therapy over another. This review attempts to provide an approach to these issues in the treatment of the cancer patient with venous thromboembolism. The role of warfarin, heparin, and low-molecular-weight heparin is discussed. Additionally, adjunctive measures, such as vena cava filter insertion and thrombotic complications associated with central venous catheters, are discussed. The review is meant to provide clinicians with practical guidelines through a review of the pertinent literature.