Hypercoagulation and duodenum adenorconoma - 1268322

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Hypercoagulation and duodenum adenorconoma - 1268322

I was forst diagnosed in June 2012 after 2 P/E one in Jan, 2012 the other in May 2012.
I had a resection of the duodenum (small intestine) in June 2012 followed by One round of Flolfox (11 trmnts) and 2 rounds of Folfiri. I am now on a third round of Folfiri. My Oncologist tells me the Folfiri is not curative and serves only to keep the cancer in check. The cancer is restricted to a few lymph nodes near the re-section site w/o metastases to other organs.

Unfortunately each time I went off chemo I suffered either a DVT (1) or a P/E (2) making a total of 4 P/Es
The last two were near fatal. I have 'failed coumadin' twice and LMH (Fragmin) twice. Once on a dose of 17.5K units per day and the second on a dose of 22.5K units/day on a split dose. I have an IVC filter in place which is clogged with clots.

I am currently on a dose of 27.5K units LMH split dose/day. My Oncologists and hematologist tell me the only way to prevent the clotting is to remain on chemo for life.

Although my doctors do not agree - I believe I have failed both coumadin and Fragmin. They offer no alternative other than the chemo. I was over therapeutic range on both of my last 2 P/E's and the DVT.

I am inclined for Quality of Life issues to switch to one of the newer oral anti-coagulants and take breaks on the chemo appropriate to my life style. Are there new anti-coagulants for cancer induced clots which i can discuss with my oncologist?

thank you


I'm very sorry for the

I'm very sorry for the problems you are experiencing. Cancer is such an awful disease. I don't think any of our members will be of much help because we don't have a focus on this type of cancer. Perhaps another forum with his particular cancer focus will provide some insight to how others are fairing.
The best of luck to your father,

Dr West
There is no remote consensus

There is no remote consensus about how to manage anticoagulation-refractory DVTs, which is why this remains a very open question for you. There are definitely new oral anticoagulants like Eliquis (apaxiban), Xarelto (rivaroxaban), and Pradaxa (dabigatran), but to my knowledge none has been studied particularly in this setting of subsequent DVTs while on therapeutic anticoagulation. We struggle by trying one after the other and may consider treating at a higher than standard dose, but I'm sorry to say that this is just a difficult situation with no clear best answer.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education