Q&A with an Expert about Blood Clots and Cancer

World Thrombosis Day

Marc Carrier

• October 13: Birthday of Rudolf Virchow, a pioneer scientist in determining why patients develop blood clots and advanced our understanding of this condition

• Increase global awareness of thrombosis and reduce death and disability caused by the disease

• More than 600 organizations in 80 Countries are participating

Blood Clots in the Legs • Deep vein thrombosis

(DVT) - A blood clot that forms in a deep vein (usually in the leg).

Tapson VF. N Engl J Med 2008; 358(10):1037-52.

Blood Clots in the Lungs

• Pulmonary embolism (PE) - A blood clot in the lungs. PE occurs when a DVT breaks free from a vein wall, travels to the lungs and blocks some or all of the blood supply to the lungs.

• DVT + PE = VTE

Tapson VF. N Engl J Med 2008; 358(10):1037-52.

Are Blood Clots Important?

• VTE is a leading cause of death and disability worldwide.– 10 million cases of VTE occur

annually • 45,000 patients in Canada

• VTE-related events kill more people than AIDS, breast cancer, prostate cancer and motor vehicle crashes combined

Are Blood Clots Frequent Among Cancer Patients?

• Cancer alone is associated with a 4 fold risk of blood clots

• Cancer and chemotherapy: 7 fold increased risk

Blood Clots are an Important Cause of Death in Cancer Patients

• Blood clot is the second leading cause of death in cancer patients

• Annual death rate for VTE is increased by 47-fold increase compared to the general population

Khorana AA et al. J Thromb Haemost 2007;5:632-4.

Figure from Khorana AA et al. Thromb Res 2010;e-pub.

Blood Clots are Associated with Decrease Quality of Life in Cancer

Patients• DVT:

1/3 patients will have long term complications such as chronic lower leg swelling, dull achy pain, leg heaviness and skin changes

• PE:–Small percentage will have chronic shortness of breath and unable to walk long distances

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Risk Factors• Growing cancer or spread to to multiple sites• Central venous catheters

– PICC lines, or Port-a-cath• Surgery• Chemotherapy

Other Risk Factors

• Obesity• Smoking• Alcohol consumption• Not moving for long periods of time (e.g.

bedrest)

Hospitalization is an Important Risk Factor

Warning Signs and Symptoms• DVT:

– Pain or tenderness, often starting in the calf• “Charlie horse”

– Swelling, including the ankle or foot– Redness or noticeable discoloration– Warmth

Tell your healthcare provider!!!

Warning Signs and Symptoms• PE:

– Unexplained shortness of breath• Especially while exercising, walking up stairs• Other day to day chores

– Rapid breathing– Chest pain (may be worse upon deep breath)

• Often feels like a sharp stab from a knife.

– Rapid heart rate– Light-headed and dizzy

Go to the ERor call 911

Prevention

• Talk about the risk of blood clots with healthcare professionals– Especially:1.During hospitalization2.Surgery3.Other high risk periods (e.g. PICC line insertion)

Prevention• Avoid known and modifiable risk factors• Anti-clotting medications

– e.g., blood thinners, referred to as "anticoagulants")• Mechanical devices

– e.g., compression stockings, intermittent pneumatic compression devices

• Hospital patients may also be instructed to move around or do foot/leg exercises as soon and as often as possible.

What are the Treatment for Blood Clots?

• Injectable blood thinner called Low Molecular Weight Heparin (LMWH)– Drug given by a needle under the skin

• Effective and no interactions with anti-cancer treatment

– Comes in pre-loaded prefilled syringesi.e. Easy to use

– Usually the injection is given once a day

What are the Treatment for Blood Clots?

• Dosing:– Depends on your weight and how well your

kidneys are working

• Treatment will continue for at least 3 to 6 months– Then your doctor will decide if you can stop or

need to continue blood thinner

Can I Have a Treatment with Pills?• Warfarin (Coumadin)

– Old “standard”– Can be high maintenance anddifficult to control in cancer patients

• Blood work….

Can I have One of the Newer Blood Thinner?

Take Home Messages

• Blood clots are common in patients with cancer

• Prevention is important• Recognition of symptoms is key to:

1. Early diagnosis2. Initiation of effective blood thinners – save lives3. Avoid long-term complications

Patient resources

•Clot Matters• http://www.clotsmatter.ca/

•Thrombosis Canada• http://thrombosiscanada.ca/

•World Thrombosis Day• http://www.worldthrombosisday.org/