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Cancer-associated pulmonary embolism — SCE Acute Medicine MCQ

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ModerateCancer, palliative care and haematologyCancer-associated pulmonary embolismSCE Acute Medicine

A 74-year-old man with a new diagnosis of pancreatic cancer develops painful swollen left calf and acute pleuritic chest pain. CTPA confirms segmental PE. Platelets are 180 × 10^9/L, eGFR is 64 mL/min/1.73m2 and there is no active bleeding. What is the most appropriate anticoagulation plan?

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Correct answer: E — Start anticoagulation, considering LMWH or a DOAC after cancer-bleeding risk assessment

Confirmed PE in active cancer requires therapeutic anticoagulation unless contraindicated. NICE supports anticoagulation with DOACs or LMWH, with GI cancer bleeding risk and drug interactions considered carefully. IVC filters are reserved for situations where anticoagulation is contraindicated or recurrent PE occurs despite adequate anticoagulation.

Reference: NICE NG158