Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Unusual venous thrombosis

James D. Douketis, Marc Carrier and Mark A. Crowther
CMAJ June 10, 2014 186 (9) 697-698; DOI: https://doi.org/10.1503/cmaj.114-0043
James D. Douketis
Department of Medicine, McMaster University, Hamilton, Ont., and President, Thrombosis Canada, Montréal, Que. (Douketis); Department of Medicine (Carrier), University of Ottawa, Ottawa, Ont.; Department of Medicine (Crowther), McMaster University, Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marc Carrier
Department of Medicine, McMaster University, Hamilton, Ont., and President, Thrombosis Canada, Montréal, Que. (Douketis); Department of Medicine (Carrier), University of Ottawa, Ottawa, Ont.; Department of Medicine (Crowther), McMaster University, Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mark A. Crowther
Department of Medicine, McMaster University, Hamilton, Ont., and President, Thrombosis Canada, Montréal, Que. (Douketis); Department of Medicine (Carrier), University of Ottawa, Ottawa, Ont.; Department of Medicine (Crowther), McMaster University, Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

In a CMAJ practice article, Schattner1 provides guidance regarding when to test for thrombophilia and when to screen for occult cancer in patients with unprovoked venous thromboembolism (VTE). This issue is important, because unprovoked VTE is common (about 20 000 cases a year in Canada),2 and indiscriminate thrombophilia testing and extensive cancer screening occur frequently in clinical practice. We wish to emphasize two points. First, thrombophilia testing should be avoided because it does not affect clinical management in most patients.3,4 Even if a thrombophilic abnormality is found, such as the factor V Leiden or prothrombin mutation, its presence does not affect risk for recurrent VTE and, therefore, does not affect decisions about continuing or stopping anticoagulant therapy. Exceptions to this premise occur; the antiphospholipid antibody syndrome or protein S or C deficiency will warrant long-term anticoagulation, but such cases are rare (< 5%). Overall, testing for thrombophilia rarely affects patient management, often yields false positive results and may adversely influence insurability of patients. We urge clinicians to consult colleagues with expertise in thrombosis before testing for thrombophilia.

Second, although screening for cancer (i.e., abdominopelvic CT, colonoscopy) may increase the number of cancers detected, it does not appear to improve cancer-related mortality, morbidity or quality of life.4 Moreover, such screening may incur procedure-related complications and psychological burden from false positive results.5 Ongoing randomized trials are assessing the risks and benefits of comprehensive screening for cancer in unprovoked VTE (NCT00773448, NCT01107327). In the meantime, we suggest age- and sex-appropriate screening for cancer, with additional testing only if patients have symptoms that are suspicious for malignant disease.

References

  1. ↵
    1. Schattner A
    . Unusual venous thrombosis in a 35-year-old man. CMAJ 2014;186:51–5.
    OpenUrlFREE Full Text
  2. ↵
    1. Spencer FA,
    2. Gore JM,
    3. Reed G,
    4. et al
    . Venous thromboembolism and bleeding in a community setting. The Worcester Venous Thromboembolism Study. Thromb Haemost 2009;101:878–85.
    OpenUrlPubMed
  3. ↵
    1. Kyrle PA
    . Venous thrombosis: Who should be screened for thrombophilia in 2014? Pol Arch Med Wewn 2014;124:65–9.
    OpenUrl
  4. ↵
    1. Howard LS,
    2. Hughes RJ
    . NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing. Thorax 2013;68:391–3.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Kleinjan A,
    2. van Doormaal FF,
    3. Prins MH,
    4. et al
    . Limitations of screening for occult cancer in patients with idiopathic venous thromboembolism. Neth J Med 2012;70:311–7.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 186 (9)
CMAJ
Vol. 186, Issue 9
10 Jun 2014
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Unusual venous thrombosis
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Unusual venous thrombosis
James D. Douketis, Marc Carrier, Mark A. Crowther
CMAJ Jun 2014, 186 (9) 697-698; DOI: 10.1503/cmaj.114-0043

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Unusual venous thrombosis
James D. Douketis, Marc Carrier, Mark A. Crowther
CMAJ Jun 2014, 186 (9) 697-698; DOI: 10.1503/cmaj.114-0043
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Coexisting failures do not diminish the stature of a giant
  • Dare we hope
  • Highlighting obesity as a risk factor for endometrial cancer
Show more Letters

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire