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What to Know About Clots & Cancer

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Blood clots in the veins of the lungs and legs are common in patients who are receiving treatment for cancer. However, the symptoms of blood clots are often difficult to recognize.

Presented by Dr. Eric Tseng MD MScCH FRCPC, Staff Physician, Hematology & Thrombosis at St. Michael’s Hospital, this webinar discusses what to look for, what to do if you are worried, and how to prevent and treat clots that occur during your cancer care. Held ahead of World Thrombosis Day on October 13, this webinar gets involved in the conversation and awareness campaign.

Published in: Education
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What to Know About Clots & Cancer

  1. 1. Goals for today What is a blood clot? When should I worry? How are blood clots treated? What should I do if I am worried?
  2. 2. Cancer and clots often come together 1 in 200 patients with cancer will develop a blood clot 20% of vein blood clots in North America occur with cancer or its treatment
  3. 3. Blood clots are more likely if: Chemotherapy Hormone therapy Radiation Surgery
  4. 4. Blood clots are more likely if: Growing Distant spread Hospital admission Infection
  5. 5. Blood clots are more likely if: Catheter in arm Catheter in neck
  6. 6. cdc.org
  7. 7. Deep Vein Thrombosis (DVT) Deep veins of the leg newtimes.co.r w
  8. 8. Deep Vein Thrombosis (DVT) in the leg KNEES ANKLES shutterstock.com
  9. 9. DVT: What To Look For worldthrombosisday.org
  10. 10. Pulmonary Embolism (PE) Starts in the legs as a DVT Then travels to the veins in the lung (“pulmonary arteries”) nejm.org
  11. 11. PE: What To Look For worldthrombosisday.org
  12. 12. PE: What To Look For Feeling winded Reduced exercise capacity Sharp Worse when breathing in Tightness Pressure worldthrombosisday.org
  13. 13. PE are sometimes found on CT scans even if you have not felt symptoms These “incidental” clots are usually treated like “symptomatic” ones macmillan.org.uk
  14. 14. Arm DVT (“upper extremity DVT”) You may notice: • Swelling • Pain • Soreness • Redness • Catheter sluggish when drawing blood, receiving meds brittonsukys.com
  15. 15. Why Do Clots Matter? Symptoms Delays in Cancer Treatment Hospitalization Quality of Life Can be fatal (timely treatment can be life-saving)
  16. 16. Don’t Ignore Your Symptoms! Tell Your Doctor or Nurse • Don’t assume it’s a side effect of chemo or radiation • Don’t assume it’s the flu • Don’t assume it’s a pulled muscle • Even if not PE, might be something else important
  17. 17. What to do if you are worried Emergency Room Call your Doctor Call 9-1-1
  18. 18. Venous Thrombosis is an Emergency!
  19. 19. DVT is diagnosed by ultrasound healthline.com
  20. 20. PE is diagnosed by CT scan of the chest macmillan.org.uk Contrast (dye) is used in the veins to look for clots
  21. 21. Why is it important to treat thrombosis? Prevent extension Treat symptoms of PE or DVT Avoid delays in cancer therapy Prevent recurrence
  22. 22. Blood Thinners (Anticoagulants) Prevent clots from getting bigger or breaking off Body breaks clot down over weeks to months
  23. 23. 1. Low Molecular Weight Heparin (LMWH) Enoxaparin “Lovenox” Dalteparin “Fragmin” Tinzaparin “Innohep”
  24. 24. 1. Low Molecular Weight Heparin (LMWH) • Usually once daily (sometimes twice daily) • No interactions with most chemo or foods • Dose based on weight and kidney function (*adjustment) • Coverage varies by province
  25. 25. Stoptheclot.org
  26. 26. 2. Pills: Direct Oral Anticoagulants Edoxaban “Lixiana” Rivaroxaban “Xarelto”
  27. 27. 2. Pills: Direct Oral Anticoagulants • May interact with chemo and other meds or supplements • May lead to bleeding in certain types of cancer • Similar effectiveness as needles • Can’t be used if kidneys are greatly impaired • Coverage varies by province
  28. 28. 3. Pills: Warfarin Once daily Requires blood monitoring Interactions with meds, diet Not as effective as needles Inexpensive
  29. 29. Since these medications thin the blood, they also increase the risk of bleeding healthlinkbc.ca HEAD URINE STOMACH GUT
  30. 30. Ask your doctor which blood thinner is most appropriate for you.
  31. 31. Clotting risk usually outweighs bleeding risk, especially at the beginning
  32. 32. What Can I Do Now? PREVENTION • Tell your doctor if you have had a clot before • Occasionally, preventative blood thinners are used before a clot happens* AWARENESS • Don’t ignore symptoms • Ask questions
  33. 33. Anticoagulation therapy for venous thrombosis in cancer usually lasts at least 3-6 months 3 to 6 months Cancer Diagnosis Chemotherapy? Surgery? Cancer Therapy complete? Bleeding? Catheter? Adjuvant therapy?
  34. 34. Back to our goals What is a blood clot? When should I worry? What should I do if I am worried? How are blood clots treated?
  35. 35. Back to our goals What is a blood clot? When should I worry? Blockage of veins in the leg or lungs (and occasionally arm) LEGS: swelling, redness CHEST: short of breath, pain, pressure
  36. 36. Back to our goals What should I do if I am worried? Go to the ER Speak to your doctor Call 9-1-1 Blood thinners Pills or needles How are blood clots treated?
  37. 37. Additional Resources • Thrombosis Canada: VTE and Cancer – www.youtube.com/watch?v=KVs2JDcVDXo – Pamphlets, videos, drug information (thrombosiscanada.ca) • World Thrombosis Day – worldthrombosisday.org
  38. 38. Canadian Cancer Survivor Network Contact Info 1750 Courtwood Crescent, Suite 210 Ottawa, ON K2C 2B5 Telephone / Téléphone : 613-898-1871 E-mail: jmanthorne@survivornet.ca or info@survivornet.ca Website: www.survivornet.ca Twitter: @survivornetca Facebook: www.facebook.com/CanadianSurvivorNet Instagram: @survivornet_ca Pinterest: http://pinterest.com/survivornetwork/
  39. 39. Thank you Questions? eric.tseng@unityhealth.to Twitter: @tsengeric #bloodandclots

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