Blood clots in the veins of the lungs and legs are common in patients who are receiving treatment for cancer. However, the symptoms of blood clots are often difficult to recognize. Presented by Dr. Eric Tseng MD MScCH FRCPC, Staff Physician, Hematology & Thrombosis at St. Michael’s Hospital, this webinar discusses what to look for, what to do if you are worried, and how to prevent and treat clots that occur during your cancer care. Held ahead of World Thrombosis Day on October 13, this webinar gets involved in the conversation and awareness campaign.

3. Goals for today
What is a blood
clot?
When should I
worry?
How are blood
clots treated?
What should I
do if I am
worried?

4. Cancer and clots often come together
1 in 200 patients with cancer will
develop a blood clot
20% of vein blood clots in North America
occur with cancer or its treatment

5. Blood clots are more likely if:
Chemotherapy
Hormone therapy
Radiation Surgery

6. Blood clots are more likely if:
Growing
Distant spread
Hospital
admission
Infection

7. Blood clots are more likely if:
Catheter in arm Catheter in neck

8. cdc.org

9. Deep Vein Thrombosis (DVT)
Deep
veins of
the leg
newtimes.co.r
w

10. Deep Vein Thrombosis (DVT) in the leg
KNEES
ANKLES
shutterstock.com

11. DVT: What To Look For
worldthrombosisday.org

12. Pulmonary
Embolism (PE)
Starts in the legs
as a DVT
Then travels to
the veins in the
lung (“pulmonary
arteries”) nejm.org

13. PE: What To Look For
worldthrombosisday.org

14. PE: What To Look For
Feeling winded
Reduced exercise capacity
Sharp
Worse when
breathing in
Tightness
Pressure
worldthrombosisday.org

15. PE are sometimes
found on CT scans
even if you have
not felt symptoms
These “incidental”
clots are usually
treated like
“symptomatic” ones macmillan.org.uk

16. Arm DVT (“upper extremity DVT”)
You may notice:
• Swelling
• Pain
• Soreness
• Redness
• Catheter sluggish when
drawing blood, receiving meds
brittonsukys.com

17. Why Do Clots Matter?
Symptoms
Delays in Cancer Treatment
Hospitalization
Quality of Life
Can be fatal (timely treatment can be life-saving)

18. Don’t Ignore Your Symptoms!
Tell Your Doctor or Nurse
• Don’t assume it’s a side effect of chemo or radiation
• Don’t assume it’s the flu
• Don’t assume it’s a pulled muscle
• Even if not PE, might be something else important

19. What to do if you are worried
Emergency
Room Call your
Doctor
Call 9-1-1

20. Venous Thrombosis
is an Emergency!

21. DVT is diagnosed by ultrasound
healthline.com

22. PE is diagnosed by CT scan of the chest
macmillan.org.uk
Contrast (dye) is
used in the veins to
look for clots

23. Why is it important to treat
thrombosis?
Prevent
extension
Treat symptoms
of PE or DVT
Avoid delays in
cancer therapy
Prevent
recurrence

24. Blood Thinners (Anticoagulants)
Prevent clots from getting
bigger or breaking off
Body breaks clot down over
weeks to months

25. 1. Low Molecular Weight Heparin
(LMWH)
Enoxaparin
“Lovenox”
Dalteparin
“Fragmin”
Tinzaparin
“Innohep”

26. 1. Low Molecular Weight Heparin
(LMWH)
• Usually once daily (sometimes twice daily)
• No interactions with most chemo or foods
• Dose based on weight and kidney function
(*adjustment)
• Coverage varies by province

27. Stoptheclot.org

28. 2. Pills: Direct Oral Anticoagulants
Edoxaban
“Lixiana”
Rivaroxaban
“Xarelto”

29. 2. Pills: Direct Oral Anticoagulants
• May interact with chemo and other meds or
supplements
• May lead to bleeding in certain types of cancer
• Similar effectiveness as needles
• Can’t be used if kidneys are greatly impaired
• Coverage varies by province

30. 3. Pills: Warfarin
Once daily
Requires blood monitoring
Interactions with meds, diet
Not as effective as needles
Inexpensive

31. Since these medications thin the
blood, they also increase the risk of
bleeding
healthlinkbc.ca
HEAD
URINE
STOMACH
GUT

32. Ask your doctor which
blood thinner is most
appropriate for you.

33. Clotting risk usually outweighs bleeding
risk, especially at the beginning

34. What Can I Do Now?
PREVENTION
• Tell your doctor if you have had a clot before
• Occasionally, preventative blood thinners are
used before a clot happens*
AWARENESS
• Don’t ignore symptoms
• Ask questions

35. Anticoagulation therapy for venous
thrombosis in cancer usually lasts at
least 3-6 months
3 to 6
months
Cancer
Diagnosis
Chemotherapy?
Surgery?
Cancer Therapy
complete?
Bleeding?
Catheter?
Adjuvant
therapy?

36. Back to our goals
What is a blood
clot?
When should I
worry?
What should I
do if I am
worried?
How are blood
clots treated?

37. Back to our goals
What is a blood
clot?
When should I
worry?
Blockage of veins in the
leg or lungs (and
occasionally arm)
LEGS: swelling, redness
CHEST: short of breath,
pain, pressure

38. Back to our goals
What should I
do if I am
worried?
Go to the ER
Speak to your doctor
Call 9-1-1
Blood thinners
Pills or needles
How are blood
clots treated?

40. Additional Resources
• Thrombosis Canada: VTE and Cancer
– www.youtube.com/watch?v=KVs2JDcVDXo
– Pamphlets, videos, drug information
(thrombosiscanada.ca)
• World Thrombosis Day
– worldthrombosisday.org

41. Canadian Cancer Survivor Network
Contact Info
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
Pinterest: http://pinterest.com/survivornetwork/

42. Thank you
Questions?
eric.tseng@unityhealth.to
Twitter: @tsengeric
#bloodandclots