Management of thromboembolism in patients with cancer.

PURPOSE/OBJECTIVES: To review the phenomenon of thromboembolism in patients with cancer, discuss treatment options for deep vein thrombosis (DVT), and describe oncology nurses' role.

DATA SOURCES

Published articles, abstracts, professional communications, drug manufacturer information, and personal clinical experience.

DATA SYNTHESIS

The incidence of DVT in patients with cancer can be as high as 15%. The cause of thromboembolism is multifactorial and includes tumor type, alterations in coagulation, specific chemotherapy agents, and clinical considerations. Although these patients traditionally have been treated with standard unfractionated heparin (UFH) therapy, low molecular weight heparin (LMWH) has been studied extensively and is an acceptable alternative treatment. LMWH should be followed by a period of oral anticoagulants, although some patients may benefit from long-term heparin therapy. Oncology nurses are qualified to identify patients who are at risk for DVT and, in expanded roles, may manage patients on anticoagulant therapy successfully.

CONCLUSIONS

LMWH followed by a course of oral anticoagulant therapy is an alternative way to treat DVT. Treatment with LMWH is less expensive than traditional UFH and has a preferred side effect profile.

IMPLICATIONS FOR NURSING PRACTICE

All oncology nurses should be aware of the different risk factors for DVT in patients with cancer and current clinical management should DVT occur. Oncology nurses in expanded roles or advanced practice nurses may choose to manage DVT with LMWH followed by oral anticoagulant therapy. Some patients may require long-term treatment with heparin therapy rather than oral anticoagulants.