Case 93 – update 4

Our patient has had one left leg DVT which was treated with rivaroxaban. He had no symptoms of malignancy. Two months later he presents again with increased leg swelling and pain and has the thrombosis has increased compared to previous. A recurrent DVT is diagnosed despite compliance with anticoagulation. He has a CT scan which suspects pancreatic malignancy and he undergoes surgery two weeks later. Because of the high risk of bleeding during the procedure and the likelihood he will require a significant amount of time without anticoagulation postoperatively he has an IVC filter inserted.


Post operatively he recovers well and after two weeks he is back on full dose anticoagulation and the IVC filter is removed.

Three months after the recurrence he is deemed cancer free and has no more treatment planned.



  • What is the optimal anticoagulation for cancer-associated VTE?
  • How long should patients be anticoagulated for?

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