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In this episode of the Oncology Brothers podcast, we delved into the complexities of venous thromboembolism (VTE) part of our Challenging Case series. We are joined by Dr. Jennifer Vaughn and Dr. Nicolas Gallastegui Crestani from The Ohio State University, who shared their expertise in hematology.
We kicked off the discussion with a case of a 34-year-old male presenting with lower extremity DVT and pulmonary embolism (PE). Dr. Vaughn emphasized the importance of considering a hypercoagulable workup, especially in younger patients with no obvious risk factors, while Dr. Gallastegui highlighted the high recurrence risk in such cases and the need for long-term anticoagulation.
As we explored the nuances of treatment options, we discussed the role of anticoagulation duration for both provoked and unprovoked events. For unprovoked DVT and PE, long-term treatment is often necessary, while provoked cases typically require three to six months of anticoagulation.
We then transitioned to a common scenario involving a young woman with stage 3 breast cancer who developed a PE before starting neoadjuvant chemotherapy. Dr. Vaughn outlined the guidelines for managing anticoagulation in cancer-associated VTE, stressing the need for ongoing treatment during cancer therapy and for three months post-treatment.
In our rapid-fire segment, we tackled various scenarios, including the management of superficial vein thrombosis, portal vein thrombosis, and considerations for patients with antiphospholipid syndrome (APLS). Dr. Vaughn shared insights on the use of DOACs versus warfarin in APLS patients based on recent trial data.
Throughout the episode, we emphasized the importance of shared decision-making and patient preferences in determining the best course of action for VTE management.