Upper extremity deep venous thrombosis (UEDVT) makes approximately 4% to 20% of all venous thromboembolism (VTE). Cancer is the most relevant acquired thrombotic risk factor of VTE, because of its myriad of prothrombotic molecules released by neoplastic cells. In our case report we presented deep venous thrombosis (DVT) of the upper limb that is not associated with central venous catheter (CVC) or receiving chemotherapy or hormonal therapy.
A 55-year old female patient was admitted to our Department of Transfusion Medicine because of the swelling and pain in the left arm. One month earlier she underwent left segmentectomy and axillary dissection because of the breast cancer. Physical examination revealed left arm swelling and pressure pain. D-dimers were 770 μg/L (normal range 170-500 μg/L). Duplex ultrasound revealed thrombogenic mass in the left brachial vein, without total obstruction. She was treated with low molecular mass heparin (LMWH) and warfarin.
This uncommon presentation of hypercoagulable state in cancer patient points out one more time the importance of prophylactic use of anticoagulants in any hospitalized cancer patient receiving anticancer therapy. In University Hospital for Tumors we recommend anticoagulation prophylaxis for all cancer patients undergoing surgery. We use low doses of LMWH eight hours after surgery and once daily until discharge.Na duboku vensku trombozu gornjih ekstremiteta (DVTGE) otpada 4% - 20% svih slučajeva venskog tromboembolizma (VTE). Maligna bolest je značajniji stečeni rizični factor za razvoj VTE zbog protrombotskih tvari koje otpuštaju neoplastične stanice. U ovom radu prikazali smo slučaj bolesnice koja je razvila duboku vensku trombozu (DVT) ruke koja nije povezana sa središnjim venskim kateterom, aplikacijom kemoterapije ili hormonske terapije.
55 - godišnja bolesnica primljena je na Zavod za transfuzijsku medicinu zbog otekline i boli u lijevoj ruci . Mjesec prije bila je podvrgnuta kirurškom zahvatu zbog karcinoma dojke, učinjena je segmentektomija s disekcijom aksile. Fizikalnim pregledom nađe se otok lijeve ruke. Vrijednost D- dimera kod prijema bila je 770 g / L (normalni raspon 170-550 g / L). Obojanom ultrazvučnom obradom nađu se trombogene mase u lijevoj brahijalnoj veni, bez potpune opstrukcije. U terapiju je uveden niskomolekularni heparin (LMWH), a potom varfarin.
Ovakva rijeđa posljedica hiperkoagulabilnog stanja kod onkoloških bolesnika još je jedna potvrda važnosti procjene rizika i profilaktičke upotrebe antikoagulantne terapije.U Klinici za tumore preporuča se antikoagulantna terapija kod svih bolesnika podvrgnutih kirurškom liječenju. Koristi se LMWH osma sati nakon operacije, a potom jednom dnevno do otpusta
