Lovenox (blood thinner) for extensive blood clot in PICC line of cancer patient

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This topic contains 5 replies, has 3 voices, and was last updated by  Dr West 2 years ago.

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October 2, 2012 at 11:12 pm  #1248589    

gautam2

Hi,

My mom is a stage IIIC Ovarian cancer patient. The surgeon put a PICC line for TPN after her abdomen surgery. The left arm that had PICC line developed extensive clotting. Her Oncologist has suggested Lovenox for her lifetime.

I have a couple of questions: Was it the right decision on part of the surgeon to put a PICC line knowing that the patient can easily develop clots due to weak immune system. Mom had four chemo sessions and one abdomen surgery?

Second: How serious are these extensive clots in the arm? Can they easily turn into PE or heart stroke? Are there any major side effects of Lovenox?

I came to this forum because the doctors are very reluctant to answering these kind of questions. Their responses are always in a language which is not definitive.

I would appreciate any response.

Thanks.

October 3, 2012 at 5:58 am  #1248596    

catdander forum moderator

Hi gautam,
Welcome to Grace. It sounds like you understand we don’t cover expertise in ovarian cancer but I can link you to blog/posts about blood clots and solid tumors including lung and ovarian cancers.

Basically it says that clotting is very common in solid tumor cancers (as opposed to lymphomas). They are commonly treated with thinning agents such as Lovenox. From reading inquiries here on Grace I have come to understand that once a person is put on as drug like lovenox they usually stay on it because clotting is very much a product of solid tumor cancers.

So it sounds like your mom is on the right treatment.

This blog/post discribes the reasoning behind prescribing the drug in your mom’s case. Note that there are link at the bottom of the blog for addition reading on the subject.

http://cancergrace.org/cancer-101/2009/12/22/cancer-and-clotting-protecht/

I hope this helps in what a know is a very difficult time.
All the best,
Janine
forum moderator


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

October 3, 2012 at 7:37 pm  #1248628    

Dr West

Clots are very common in people with cancer for several reasons. The underlying cancer increases the risk of a clot, chemotherapy can irritate the inside lining of blood vessels and contribute, and having lines in can also be a factor. But that doesn’t mean that chemo or indwelling IV lines like a PICC isn’t appropriate. They are very often needed and quite helpful, but yes, there is a risk of blood clots. People get blood clots very commonly even without a PICC line, and cancer patients are 4-6 times more likely than other people.

There is always a risk of blood clots propagating to lungs or elsewhere, but most often, blood thinners like lovenox are effective. Lovenox or another blood thinner are unquestionably the standard of care and have a benefit that far outweighs risk in this setting, with the main risk being bleeding (it is a blood thinner, after all), and a very small risk of triggering an immune response that can lower the platelet count. The latter is really very uncommon, and the vast majority of patients do well on it.

Good luck.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

October 15, 2012 at 1:44 pm  #1249068    

gautam2

Dr West,

Thanks for your response.

My mom is doing well so far. She had her omentum surgery done and is feeling fine. When her cancer was first detected around 6 months ago, her CA 125 was around 3000 and after 4 chemos and 1 surgery it’s 700. The last CA 125 test was done 3 weeks after the surgery. In surgeon’s opinion, the number is inflated because of recent surgery. But the Oncologist is very worried. In her opinion, it’s a really bad news because it looks like chemo, Carboplatin and Taxol, is not working and outlook of any kind remission are very grim. She is worried that my mom may not have much time left.

I am confused in the sense that two doctors have considerably different opinions.

There is no visible tumor left. There are no signs of ascites building up. There will be some but not that significant. My understanding was then when when the surgeon can not find any visible sign of tumor, it’s considered optimal debulking and the long-term survival rate gets better.

Please help me understand what’s going on.

Thanks.

October 16, 2012 at 8:31 am  #1249098    

catdander forum moderator

From Mayo Clinic there is this information,
“Definition
By Mayo Clinic staff
A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in your blood.

Many different conditions can cause an increase in CA 125. These include uterine fibroids, endometriosis, pelvic inflammatory disease and cirrhosis, as well as pregnancy and normal menstruation. Certain cancers, including ovarian, endometrial, peritoneal and fallopian tube, also can cause CA 125 to be released into the bloodstream.

A CA 125 test isn’t accurate enough to use for cancer screening in all women — especially premenopausal women — because many benign conditions can increase the CA 125 level. What’s more, CA 125 levels are normal in many women with early-stage ovarian cancer.”

http://www.mayoclinic.com/health/ca-125-test/MY00590

As in lung cancer you can’t bet on a blood test to give an accurate accounting of what’s really happening. So a wait and see is probably what will tell the truth. I’m sorry that is a non answer but is so often the case when trying to follow cancer. I hope the numbers go down with time and your mom is good.
Janine


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

October 16, 2012 at 8:38 pm  #1249116    

Dr West

I agree that especially after surgery, the tumor marker number can be artificially high. I have a patient who was sent to me several years ago after surgery because of an elevated CA-125 or CEA, told by the referring doctor that she had either recurrent lung cancer or ovarian cancer. I suspected that was a very inaccurate overall, and I was right. Her tumor marker dropped over the next few months, and over the subsequent 3-4 years, she has shown no evidence of recurrent cancer or any new one. So the reason you’re getting mixed messages from the two doctors is that one is wrong — it happens. I’d be hopeful that the more optimistic interpretation is correct.

Good luck.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

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