Role of Anticoagulation in the Management of Tumor Thrombus: A 10 year
single center experience
Abstract
Background: Children with cancer diagnosis are overall at a higher risk
of thrombosis. For a newly diagnosed bland thrombus, patients are
commonly started on anticoagulants to prevent further extension and
embolization of the clot. In the rare instance that a pediatric patient
has a tumor thrombus, the role of anticoagulation is less clear.
Procedure/Methods: Patients under 21 years of age with a finding of
tumor thrombus on imaging from 2010-2020 at Texas Children’s Hospital
were identified and their medical records were reviewed. Results: A
total of 50 patients were identified. Most thrombi were incidental
findings at diagnosis; however, there were two patients who presented
with pulmonary embolism (PE). Inferior Vena Cava extension was noted in
36% of the patients and 24% patients had an intracardiac tumor
thrombus. Hepatoblastoma (26%) was the most common malignancy
associated with tumor thrombus. Anticoagulation was initiated in 10
patients (20%). Only 2 of these 10 patients showed response to
anticoagulation. However, 40% (4/10) patients in the anticoagulation
cohort were noted to have bleeding complications (p <.05).
Conclusion: Children with intravascular extension of solid tumors were
not commonly started on anticoagulation at the time of diagnosis,
irrespective of the extent of tumor thrombus. Furthermore, we observed a
significant trend toward higher incidence of bleeding complications
after initiation of anticoagulation. There is inadequate evidence at
this time to support routine initiation of anticoagulation in pediatric
patients with intravascular extension of solid tumors.