Efficacy of Prophylactic Measures in Prevention of Deep Venous Thrombosis in Cancer Patients

Abstract

SUMMARY D eep venous thrombosis is considered to be one other challenges in medical practice because of silent nature in the most of the cases & the complications that result that may end with death. It's very difficult to study its incidence. There is strong relation between malignancy & thrombosis. The incidence of deep venous thrombosis in malignancy differs according to the type of the tumour. There are many risk factors of deep venous thrombosis other than malignancy like surgery, history of previous attack, immobility, obesty, pregnancy, and contraceptives, & others. The incidence differ from one risk factor to another & also according to presence of other co-morbidities. venous thrombosis occurs as a result of one or more three factors postulated by Virchow either abnormalities of blood flow, abnormalities of blood or vascular injury. Deep venous thrombosis in malignancy may be due to other causes like surgery, chemotherapy or central venous catheters. The normal venous endothelium is antithrombotic, producing many factors like prostaglandin –I, tissue plasminogen activator & many other factors that inhibit thrombosis under normal conditions. Exposure of any of the factors to Virchow's triad will lead to induction of procoagulant activity, suppression of anticoagulant mechanisms. Tumour cells can activate blood coagulation through multiple mechanisms, including production of procoagulant, fibrinolytic & proaggregating activities; release of pro inflammatory cytokines & direct interactions with vascular & blood cells through adhesion molecules. Diagnosis of deep venous thrombosis is very challenging because the limb that to be entirely normal clinically may harbor life threatening clots & the limb with all the typical symptoms & signs of deep venous thrombosis may prove to be normal. There are multiple symptoms & signs that may be common with other diseases. Like pain, swelling & colour changes Diagnosis is by clinical assessment, imaging and biological tests. The most commonly used method is acombination of venous duplex and clinical assessment. The aim of medical practice should be directed to prevent deep venous thrombosis, early diagnosis & effective treatment before complications happen. Prophylaxis is either primary or secondary, There are two methods of prophylaxis the first method is non pharmacological and the second method is pharmacological like heparin, low-molecular weight heparin, oral anticoagulants, Fondaparinux and New anticoagulants. Prophylaxis of deep venous thrombosis among cancer patients is more important because patients are of high risk of developing thrombosis, Treatment of DVT is less effective, associated with more bleeding complications. Treatment of DVT include general measures like bed rest & limb elevation, use of UFH, LMWH, oral anticoagulants Thrombolytic agents or surgical treatment. Heparin, oral anticoagulants & thrombolytic therapy needs dose adjustment & have many complications. So the new oral anticoagulant have potential to serve more ideal and advantageous treatment option for DVT. Deep venous thrombosis has many complications like pulmonary embolism, chronic venous insufficiency, secondary varicose veins.