الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
eep venous thrombosis (DVT) and pulmonary embolism (PE), together called venous thromboembolism (VTE), remain a serious health care problem. The best estimates suggest that there are over 900, 000 cases of VTE per year in the United States of which 300, 000 individuals die of PE every year.
Symptomatic DVT is particularly common among cancer patients, occurring in as many as 15% during the clinical course of their disease. Compared with patients without cancer, cancer patients who have DVT are at increased risk for recurrent venous thromboembolism (VTE) and anticoagulation associated bleeding. In addition, cancer patients with VTE have a twofold higher mortality rate than cancer patients without thrombotic events.
Cancer is an acquired thrombophilic condition. Cancer patients commonly present with a hypercoagulable state, even in the absence of thrombosis. Furthermore, clotting activation may play a role in tumor progression. The pathogenesis of thrombosis in cancer is multi factorial; however, a relevant role is attributed to the tumor cell capacity to interact with and activate the host hemostatic system. The prothrombotic action of antitumor therapies is also important. Thrombotic events can influence the morbidity and mortality of the underlying disease.
In view of the well-recognized risk of VTE in established cancer, it has been suggested that idiopathic VTE may predict the presence of occult cancer. This could lead to the recommendation of screening for very early (i.e. treatable) cancer in patients presenting with idiopathic VTE. In two studies in which patients presenting with VTE underwent intensive investigation for cancer, the incidence of occult cancer was detected in up to 1 in 4 patients.
The clinical diagnosis of deep venous thrombosis is not accurate as the signs and symptoms are not specific and when present may be explained by numerous and other etiologies, thus objective methods to establish this diagnosis are required.
The clinical presentation of deep vein thrombosis is quite variable, it may be asymptomatic or it may be present in the form of venous gangrene or fatal pulmonary embolism.In between these two extremes the majority of patients give symptoms and signs that can be induced by wide variety of pathological processes.
The main goals of treatment for DVT include prevention of PE and recurrent thrombosis. Once VTE is suspected, anticoagulation should be started immediately unless there is a contraindication.
Thrombolytic therapy for DVT may be beneficial in selected patients, and although it can be administered systemically, local infusion under catheter directed therapy (CDT) is preferred.
The placement of inferior vena cava (IVC) filters has increased dramatically. Filters have proven to be a viable alternative to anticoagulation therapy for the prevention of life threatening pulmonary emboli (PE) for patients who have contraindications to anticoagulation therapy.
Consensus guidelines recommend the use of anticoagulant therapies for thromboprophylaxis in hospitalized patients with cancer and patients undergoing cancer surgery.