Venous thromboembolism recurrence and intracranial hemorrhage in the cancer patient: A fatal course

Objective: Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant source of morbidity and mortality in individuals with malignancies. Thromboprophylaxis is commonly employed in the management of most cancer patients, with the most common side effect being bleeding. It is not uncommon for patients to experience a recurrence of VTE during their treatment, highlighting a notable gap in the available evidence on this issue. Case: A 67-year-old male patient, actively undergoing chemotherapy for lung adenocarcinoma and initiated on low molecular weight heparin (LMWH) due to the development of PE, presented to the emergency department with DVT as a consequence of irregular use of anticoagulant injections. The patient, after being re-administered heparin, subsequently presented with intracranial hemorrhage on the 5th day post-discharge, ultimately leading to a fatal outcome. Conclusion: Both cancer patients and the elderly are at a heightened risk of experiencing VTE recurrence. The initiation of anticoagulation treatment elevates the risk of bleeding, particularly within the first ten days. Despite the frequent presentation of VTE recurrence in cancer patients at emergency departments, it remains underreported.