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cardio.dvt.cancer-associated.v1

Cancer-associated DVT (CAT)

cardiologyacuteadultacuteinpatienttransitionoutpatient
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Phase E variant of cardio.dvt.core.v1 — narrowed to cancer-associated thrombosis (CAT) phenotype: active malignancy at DVT dx or within preceding 6 months. Inherits diagnostic arc from parent via routing; specializes for cancer-specific AC choice (DOAC for non-mucosal per CARAVAGGIO/Hokusai-Cancer; LMWH for luminal GI / intracranial per CLOT + ISTH 2022 subgroup signals), indefinite AC while cancer active, chemotherapy drug interaction management, and API-CAT 2024 extended apixaban (months 7-18, PMID 38780119). Manifest pointer reuses cardio.dvt.core.v1 manifest. Design-brief pointer reuses parent (CAT-specific differences documented inline). Critical decision matrix per cancer type: non-mucosal solid (DOAC); luminal GI (LMWH); intracranial (LMWH or hold); hematologic (case-by-case with hem-onc). Drug interactions and thrombocytopenia management are central distinguishing features vs general DVT. Status INTEGRATED. Authored 2026-05-14 by shard-06-cardio-acute as cancer-associated DVT variant.

Entry points (3)

  • history
    Active cancer (treatment within 6 months OR metastatic) with new DVT → cancer-associated thrombosis (CAT)
    active_cancer_with_new_dvt
  • history
    Cancer diagnosed within preceding 6 months — CAT phenotype regardless of current treatment status
    cancer_diagnosed_within_6mo_with_dvt
  • symptom
    Unprovoked DVT in patient age ≥50 → trigger occult cancer screening per SOME (PMID 26095396); convert to CAT pathway if cancer found
    unexplained_dvt_age_50_plus

Required inputs (7)

  • agerequired
    demographic • used at CONTEXT
    Older patients higher cancer risk and AC tolerability concerns
  • cancer_type_and_stagerequired
    history • used at TREATMENT
    Cancer type drives DOAC vs LMWH choice — luminal GI and intracranial malignancy favor LMWH; non-mucosal cancers DOAC equivalent
  • current_chemotherapyrequired
    history • used at TREATMENT
    Drug interaction screen: many chemotherapies and supportive care drugs interact with DOACs (e.g., azoles, rifampin equivalents, P-gp inducers)
  • compression_usrequired
    imaging • used at INITIAL_WORKUP
    Confirm DVT location and burden
  • cbcrequired
    lab • used at INITIAL_WORKUP
    Baseline platelet count; thrombocytopenia from chemotherapy modifies AC dosing or contraindicates AC entirely if severe
  • creatininerequired
    lab • used at TREATMENT
    eGFR for DOAC dosing; cancer patients often have AKI from chemotherapy or contrast
  • mucosal_bleed_historyrequired
    history • used at RED_FLAGS
    Mucosal bleed history (especially in GI/GU cancers) shifts choice from DOAC to LMWH

12-phase flow (10)

  1. 1FRAME
    Cancer-associated thrombosis (CAT) — distinct phenotype with higher recurrence + bleed risk; indefinite AC while cancer active is default; cancer type drives DOAC vs LMWH choice
    inputs: cancer_type_and_stage
    advance: cancer status confirmed
  2. 2ENTRY
    Wells score, US for DVT confirmation; cancer activity reassessment (active treatment, metastatic, in remission)
    inputs: age
    advance: DVT confirmed and CAT classification made
  3. 3CONTEXT
    Cancer type, stage, treatment plan, prognosis (informs AC duration and shared decision); chemotherapy and supportive care drug list for interaction screen
    inputs: current_chemotherapy, cancer_type_and_stage
    advance: cancer + drug context complete
  4. 4RED_FLAGS
    Severe thrombocytopenia (<50K) — AC modification or platelet support; brain metastases — DOAC contraindicated, LMWH preferred; recent GI/GU bleed; intracranial hemorrhage; absolute AC contraindication
    inputs: mucosal_bleed_history
    advance: red flags screened
  5. 5INITIAL_WORKUP
    Compression US confirms DVT; CBC + BMP + coags; LFTs (impact AC); recent imaging review for cancer status
    inputs: compression_us, cbc, creatinine
    actions: panel.cardiac, panel.renal
    advance: workup documented
  6. 6BRANCHING_WORKUP
    Cancer type categorization: non-mucosal solid tumor (DOAC eligible) vs luminal GI cancer (LMWH preferred per CARAVAGGIO subgroup) vs intracranial malignancy (LMWH or no AC if intracranial bleed risk extreme) vs hematologic malignancy (case-by-case with hem-onc input)
    advance: AC strategy per cancer type documented
  7. 7TREATMENT
    First-line: apixaban 10 mg BID × 7 d → 5 mg BID × 6 mo (CARAVAGGIO PMID 32223112) OR edoxaban 60 mg daily after 5 d LMWH lead-in (Hokusai-Cancer PMID 29231094) for non-mucosal cancers. LMWH (dalteparin or enoxaparin) for luminal GI, intracranial malignancy, or DOAC contraindication (CLOT PMID 12853587)
    inputs: creatinine, mucosal_bleed_history
    advance: AC initiated per cancer type
  8. 8DISPOSITION
    Outpatient if hemodynamically stable; inpatient for severe symptoms, severe thrombocytopenia management, or chemotherapy timing coordination
    advance: unit assigned
  9. 9MONITORING
    Bleeding screen (especially mucosal sites); CBC weekly during chemotherapy; LFTs monthly; reassess cancer status every 3 mo (impacts AC continuation decision)
    actions: panel.cardiac
    advance: monitoring plan documented
  10. 10FOLLOWUP
    6-month landmark: continue AC if cancer active OR API-CAT 2024 extended apixaban (months 7-18) for active cancer (PMID 38780119); reassess at 12 mo and beyond per cancer status; stop only when cancer in durable remission
    advance: extended-AC plan documented