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Cancer-associated Thrombosis — SCE Medical Oncology MCQ

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HardOncological EmergenciesCancer-associated ThrombosisSCE Medical Oncology

A 72-year-old man on palliative chemotherapy for metastatic gastric cancer develops a sudden painful swollen left leg. Doppler ultrasound confirms an extensive ileofemoral DVT. He has a platelet count of 45 × 10⁹/L. What anticoagulation approach is most appropriate?

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Correct answer: D — Full-dose LMWH immediately

Cancer-associated thrombosis with thrombocytopenia requires careful management. For platelet counts 25,000-50,000/µL, therapeutic LMWH can be given with platelet support (transfuse to maintain >50,000/µL). DOACs are not recommended in severe thrombocytopenia. Below 25,000/µL, the risk-benefit of anticoagulation must be individualised. IVC filters are considered only when anticoagulation is absolutely contraindicated. LMWH is preferred over DOACs in cancer-associated VTE with thrombocytopenia due to easier dose adjustment and reversal.

Reference: NICE NG158 VTE diseases; ISTH Guidance for anticoagulation in cancer-associated VTE with thrombocytopenia 2022