Part 4: Venous Thromboembolism

Elisabeth M. Battinelli, MD, PhD

Assistant Professor of Medicine, Harvard Medical School, Associate Physician, Division of Hematology, Brigham and Women's Hospital, Boston, MA

Jean M. Connors, MD

Assistant Professor of Medicine, Harvard Medical School, Medical Director, Anticoagulation Management Service, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA

Question 2

A 39-year-old woman with stage IIIa breast cancer is scheduled to receive her next dose of chemotherapy. When she arrives at the oncologistís office, he notes that her left leg is swollen. The patient is sent for ultrasonography, which reveals a large DVT in her femoral vein. The oncologist recommends that the patient start on anticoagulation with low molecular weight heparin (LMWH). The patient asks how long she will need to remain on the LMWH. Which of the following statements regarding this patientís anticoagulation therapy is most correct?

  •   The patient can be started on LMWH-to-warfarin bridge today and
    should remain on warfarin for 3 to 6 months
  •   The patient should be anticoagulated with LMWH while receiving
    treatment for her cancer
  •   The patient should not be started on LMWH and instead should be
    offered treatment with a new oral anticoagulant
  •   The patient should be anticoagulated with warfarin only and does not
    need to receive LMWH initially

Updated 11/21/2013 • jdw | Copyright ©2014 Turner White Communications