A cancer diagnosis poses many challenges to patients. Chemotherapy, radiation therapy, or surgery may be needed. In addition to all the other things a new cancer diagnosis brings, we now know that as many as 1 in 5 patients with cancer will also develop an abnormal blood clot which may pose a serious health risk requiring additional medical treatment.    .

120576684What is a blood clot?

A blood clot that forms in a vein is termed a thrombus. A thrombus in a deep vein of the leg or arm is called deep vein thrombosis (DVT). A thrombus in the lung in called a pulmonary embolism (PE). Health care providers often refer to DVT, PE, or other organ clots as venous thromboembolism or VTE.

When VTE happens, chemotherapy is interrupted and new medicines (blood thinners) have to be added to a patient’s regimen. Patients may also experience long-term leg pain, shortness of breath, and an increased risk of bleeding.

What increases the risk for blood clots?

We now know many things that increase the risk of blood clots in patients with cancer. They include the type of cancer, how far the cancer has spread, decreased activity, hospitalization and many more. Some types of cancer, such as pancreas or brain, are associated with an increased risk for blood clots.

How do you prevent blood clots?

The key is to prevent clots using blood thinners, but not increase the risk of bleeding.

In order to identify patients who would most benefit from anticoagulation (blood thinners) to prevent VTE while receiving outpatient chemotherapy, the UVM Thrombosis and Hemostasis Program and Cancer Center are working together to develop a VTE risk assessment program for every patient starting chemotherapy.

With the help of the UVM Jeffords Quality Institute and using a scoring tool that is scored as high, intermediate, or low risk for blood clots, patients at high risk for blood clots during chemotherapy are offered a referral to specialists in blood clots and bleeding to discuss starting a prevention dose of anticoagulation.

A pharmacist familiar with chemotherapy and anticoagulation is also included in the consultation to provide guidance for choice of medication to optimize therapy and prevent complications of anticoagulation. The new program is called VTE Prophylaxis in the Ambulatory Cancer Clinic or VTE-PACC.

The goals of VTE-PACC are: 1) Decrease risk of VTE complications of chemotherapy, 2) Prevent unexpected hospitalization for patients receiving chemotherapy due to VTE, 3) Increase patient satisfaction and quality of life, and 4) Increase chemotherapy completion rate and decrease chemotherapy delays due to complications of clotting or bleeding.

In addition, the collection of information through the electronic medical record system will contribute to new knowledge of this complicated problem and influence the future direction of patient care.

How can I lower my risk for blood clots?

Patients with cancer may lower their risk of blood clots by staying as active as possible. Avoid bed rest if it’s not necessary, establish a modest exercise routine, and talk to your health care provider about prevention treatments if hospitalized or having surgery.

Recognize symptoms of VTE: pain or swelling in arm or leg, or associated with a port; shortness of breath, chest pain or painful breathing, racing heartbeat, pain in back or shoulder, dizziness or fainting, coughing up blood or new wheezing with usual activity.

The most important defense against potentially serious consequences of an abnormal blood clot is to understand the risk factors associated with the formation of blood clots and how to recognize the symptoms.

For more information, please visit UVMHealth.org/CancerCenter or call (802) 847-0000. Click here to learn more about the Thrombosis and Hemostasis Program at the UVM Medical Center. 

Chris Holmes, MD, is a hematologist/oncologist in the Thrombosis and Hemostasis Program at the University of Vermont Medical Center and associate professor at the Larner College of Medicine at UVM. 

Patricia Lewis, APRN, is a hematology/oncology nurse practitioner in the Thrombosis and Hemostasis Program at the University of Vermont Medical Center. 

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