Overview
Metastatic malignant neoplasm to the lower limb refers to the spread of cancer from its primary site to bones or soft tissues of the leg. This can lead to significant morbidity, including pain, pathological fractures, and venous thromboembolism (VTE) 1.Diagnosis
Diagnosis is typically established through imaging (e.g., CT, MRI, bone scan) and biopsy of the metastatic lesion 1.
Patients with cancer are at a markedly increased risk for VTE, which can be a complication of metastatic disease 1.Management
Venous Thromboembolism (VTE) Prophylaxis:
* Mechanical and pharmacological prophylaxis are considered for hospitalized medical patients with cancer and those undergoing surgery 1.
* Thromboprophylaxis is not recommended for ambulatory patients receiving chemotherapy who are at low risk of VTE 1.
VTE Treatment:
* Low-molecular-weight heparin (LMWH) is recommended for the initial treatment of VTE in patients with cancer 1.Key Recommendations
Use low-molecular-weight heparin (LMWH) for the initial treatment of VTE in patients with cancer. (Evidence: Strong) 1
Do not use thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE. (Evidence: Strong) 1
Consider thromboprophylaxis in hospitalized medical patients with cancer. (Evidence: Conditional) 1References
1 Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA et al.. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood advances 2021. link