Trousseau recognized that recurrent deep vein thrombosis could be a presenting sign for patients with occult neoplasia. These patients have a chronic DIC related to a number of factors, including release of tissue thromboplastin-like materials from the tumor.


Features of thrombophlebitis:

(1) These tend to be recurrent and migratory (occurring at different sites).

(2) The thrombosis may occur in both superficial and deep veins. Superficial veins include those of the neck, thorax and abdomen. Thromboses may involve the axillary, subclavian, or cerebral veins as well as veins to intra-abdominal viscera.

(3) Arterial thrombosis may occur.

(4) The thromboses show resistance to warfarin therapy, with improvement with therapy of the tumor.

(5) Patients respond to heparin therapy but thrombosis recurs shortly after discontinuation of therapy.


Underlying neoplasms – The most common tumors are located in:

(1) lung

(2) gastrointestinal tract

(3) pancreas

(4) renal

(5) ovarian and other gynecologic malignancies


Other associations:

(1) Particular attention should be paid to an older adult without history of previous thromboembolic disease, and especially if (a) there is no known precipitating factor or (b) the patient shows weight loss or other systemic signs of malignancy.

(2) There is an increased risk of post-surgical thrombophlebitis.

(3) The thromboses may precede discovery of the underlying malignancy by many months.

(4) The underlying malignancy may be difficult to detect despite an extensive investigation.

(5) Some of the patients may develop nonbacterial thrombotic endocarditis.


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