q&a with expert about blood clots & cancer
TRANSCRIPT
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/