The decision was made not to give thromboprophylaxis in the poll. As previously provoked DVT and also history of ongoing bleeding and iron deficiency with risk of thrombocytopenia on the chemotherapy. His Khorana score was 1 (Intermediate risk 1.8-2% chance of VTE).
You are called about the same patient a month later. His second cycle of treatment has been delayed as his platelet count is 70.
He has presented with a swollen right leg and a Doppler USS has confirmed a DVT. The medical team tell you the patient is keen for a DOAC over LMWH and are keen to hear your thoughts on the use of DOACs in cancer associated thrombosis.
What anticoagulation options would you consider for this patient? What is your preference and why?
What should the team do about the thrombocytopenia and anticoagulation? Any platelet thresholds you may use to advise the team?