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

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.