VTE treatment in palliative care

Before investigating suspected venous thromboembolism (VTE) or starting anticoagulant therapy for VTE treatment in patients with palliative care needs, consider the benefits and burdens of each intervention and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Often, anticoagulation is not practical, possible or in keeping with the patient’s goals of care; do not investigate suspected VTE in such situations.

If investigation and treatment is considered appropriate, see the Cardiovascular guidelines for details on diagnosis and treatment of VTE. The role of direct-acting oral anticoagulants (DOAC) in VTE treatment has recently expandedNoble, 2019. For additional considerations for treatment of VTE in patients with active cancer, see VTE treatment for patients with active cancer.

A variety of symptoms can be associated with VTE in patients with palliative care needs—for management, follow the Principles of symptom management in palliative care. Massive pulmonary embolism can present with cardiac arrest or sudden cardiovascular decompensation. Breathlessness, severe chest pain, and the symptoms of low cardiac output need to be urgently managedChin-Yee, 2019.

Invasive VTE therapy (eg inferior vena cava filter) is seldom appropriate in patients with a life-limiting illness if the overall prognosis is poor. If death is expected imminently, see Catastrophic terminal events for management; if death is likely to occur in the next few days, see Managing symptoms in the last days of life] for symptom management.

For information on rationalising anticoagulants, see Rationalising anticoagulants in palliative care.