Additional Information Necessary
The authors state that, after catheter-related upper extremity vein thrombosis, a functional catheter that is still required can continue to be used together with anticoagulation (1). We have many patients with portal vein thrombosis who do not want to have their port removed even after treatment completion, due to a risk of relapse (for example, breast cancer patients after adjuvant chemotherapy). If the port stays in place for a few years, how long would the authors recommend using anticoagulant drugs for these patients—for the entire time? Would a therapeutic anticoagulant dose be administered the entire time, or would it be “dialed down” to a prophylaxis dose? Which drug should be used (vitamin K antagonist, direct oral anticoagulant)? No study data exist for this. It would certainly be interesting to hear how the authors proceed in their daily practices.
In the prophylaxis section, the authors state that it is unclear whether prophylaxis has a positive influence on the incidence of deep vein thrombosis (DVT) of the upper extremity but that prophylactic anticoagulation is indicated, as tumor patients are also threatened by DVT of the lower extremity. No distinctions are made between outpatients and inpatients, or surgery patients and patients with cancer. However, there is no indication for thrombosis prophylaxis for cancer outpatients (perhaps with the exception of patients with pancreatic carcinoma treated with chemotherapy or myeloma treated with IMiDs). The guidelines also advise against thrombosis prophylaxis for cancer outpatients. For which patients would the authors then recommend a prophylactic anticoagulation, and with which anticoagulant?
Prof. Dr. med. Axel Matzdorff
Klinik für Innere Medizin II, Asklepios Klinikum Uckermark
Conflict of interest statement
Prof. Matzdorff has received consultant honoraria from LEO Pharma, and reimbursement for conference fees and travel expenses as well as speaking honoraria from Aspen, LEO Pharma, and Sanofi.
|1.||Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A: Deep vein thrombosis of the upper extremity—a systematic review. Dtsch Arztebl Int 2017; 114: 244–9 VOLLTEXT|