Cancer-Associated PE — RACP Adult Medicine MCQ

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ModerateHaematologyCancer-Associated PERACP Adult Medicine

A 55-year-old woman with known breast cancer on tamoxifen presents with acute onset dyspnoea and right-sided pleuritic chest pain. CTPA confirms a segmental pulmonary embolism. She is haemodynamically stable. What is the most appropriate initial anticoagulant?

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Correct answer: C — Apixaban

For haemodynamically stable PE in cancer patients, DOACs (apixaban or rivaroxaban) are now recommended as first-line based on SELECT-D and Caravaggio trials. Apixaban specifically showed non-inferiority to LMWH with no increased GI bleeding (Caravaggio trial), making it preferred in cancers with potential mucosal bleeding risk. Tamoxifen increases VTE risk and should be reviewed. Treatment duration is at least 6 months and often indefinite while cancer is active.

Reference: Cancer Council Australia – 2022 – Cancer-Associated VTE Guidelines; ISTH – 2023