Vanderbilt Cardio-Oncology Thrombosis Center

It has been recognized for many years that patients with cancer are at increased risk for thrombosis (blood clots). Thrombosis in cancer patients can occur in the arteries but more often occur in the leg veins and are called deep venous thrombosis (DVT).  The clot may migrate to the lungs where it is called a pulmonary embolism (PE). Thrombosis is the second most common cause of death in cancer patients. It may also be a first sign of cancer.
The Vanderbilt Cardio-Oncology program has a special and dedicated interest in the role that thrombosis plays in cancer patients. We have shown that thrombosis can occur as a complication of the cancer but also can occur as a complication of the cancer therapy. Importantly, we have formed a close collaboration between cardiologists, oncologists, hematologists and surgeons that provide individualized care for cancer patients. We work together to better understand the mechanisms of clot formation and find ways to prevent, diagnose, and treat thrombosis in cancer patients. Our group is involved in clinical trials investigating the use of newer diagnostic and treatment options.
GUIDELINES: Current guidelines recommend primary prevention of thrombosis in patients hospitalized for medical and surgical issues, as well as for highly selected ambulatory patients with cancer. The current recommendations advocate the primary use of low-molecular weight heparin as the main treatment for thrombosis in cancer patients. Formal guidelines are developed by organizations such as the American College of Chest Physicians, American Society of Clinical Oncology, and the National Comprehensive Cancer Network.
RISK OF THROMBOSIS:  Approximately 900,000 people in the United States develop thrombosis each year resulting in 100,000 deaths. 15% of the patients with PE die in the first three months after diagnosis. Patients with cancer have a 6-fold increase risk of developing thrombosis compared to non-cancer patients. Cancer patients account for 20% of all new cases of thrombosis. As part of our effort to identify cancer patients at risk for thrombosis, we are investigating models for cancer and chemotherapy-associated thrombosis. We utilize a number of modalities to identify patients with thrombosis including ultrasound imaging, high-resolution CT scanning, MRI, and molecular imaging.
PREVENTION and TREATMENT of THROMBOSIS IN CANCER PATIENTS: Prevention of thrombosis is recommended in high-risk cancer patients. We use both medications and devices – such as filters – that prevent recurrent clot formation in cancer patients. Our cardio-oncology program is also interested in identifying novel cancer treatments that increase the risk of thrombosis. For example, we have a special interest in patients with novel cancer treatments for multiple myeloma and their increased risk for thrombosis. We are also interested in novel means to treat thrombosis in cancer patients. These include novel drug therapies but also novel catheter based techniques that are used by interventional cardiologists that are placed directly in the clot and help dissolve the underlying thrombosis. In addition, our group includes cardiovascular surgeons who remove the clot using surgical techniques.
At Vanderbilt, we have made great strides for the care of cancer patients with thrombosis because of our collaborative environment that allows for the health care team to work together for the optimal care of the these unique patients. Only a few other such programs exist in the country. Specifically, we have recently implemented an acute pulmonary embolism response team (Vanderbilt PERT team) as part of a collaborative network with other centers. This group consists of cardiologists, cardiac surgeons, emergency physicians, hematologists and pulmonary physicians who form the rapid response group. Once PE is diagnosed, the team arrives at a consensus treatment for the patient and the plan is implemented immediately. The group also tracks the patients in a formal database that allows outcome determination and potential improvements in care.
ARTERIAL THROMBOSIS: Patients with cancer can also develop thrombosis in the arteries, which can manifest as heart attack, stroke or peripheral vascular occlusions. For these patients, treatment is tailored to the each unique condition given that understanding that cancer patients can also be at increased risk of bleeding, clotting, or infection. We have a detailed knowledge of the consequences of their cancer therapy and bring this to bear when considering the appropriate therapy for their heart disease. Several novel cancer treatments are also associated with an increased risk of arterial thrombosis.
We are involved in a number of investigations related to thrombosis:
1. Early identification of patients at risk for thrombosis through the use of biomarkers
2. Investigation into the relationship of thrombosis to tumor growth
3. PERT consortium - investigating optimal treatment of acute PE
4. Mechanisms of thrombosis associated with novel targeted cancer therapies
David Slosky, M.D.
Javid Moslehi, M.D.
Peter Fong, M.D.
Elias Haddad, M.D.
Sean Collins, M.D.
David Gailani, M.D.
Madan Jagasia, M.B.B.S, M.S.
Michael Petracek, M.D.
Jonathan Schoenecker, M.D., Ph.D.