Background: Thrombosis is closely related with cancer patients. Venous thromboembolism such as pulmonary thromboembolism and deep vein thrombosis are more frequently occurred in cancer patients. Arterial thromboembolism such as myocardial infarction and ischemic stroke were less occurred. Venous thromboembolism and arterial thromboembolism were rarely concomitantly occurred in cancer patients, especially ahead of cancer diagnosis.
Methods: Five patients who suffered from venous thromboembolism and arterial thromboembolism sequentially and then cancer was diagnosed were enrolled and followed up until the patient died or until June 2021. The medical records were retrospectively reviewed to evaluate the clinical characteristics, image findings and the outcomes.
Results: Three women and two men were renrolled, with a mean age of 63.2 years (range, 47-76 years). Four patients suffered from ischemic stroke, and the lesions showed by magnetic resonance manifested bilateral diffuse changes. One patient suffered from lower limb arterial thromboembolism. Four patients suffered from pulmonary thromboembolism diagnosed by CTPA or ultrasound (among them, two patients with deep venous thrombosis simultaneously), one patient suffered from solely deep venous thrombosis. Pulmonary adenocarcinoma was diagnosed in two patients, and one skin basal cell carcinoma, one ovarian clear cell adenocarcinoma and one rectal adenocarcinoma were diagnosed in the other three patients. Four patients received cancer related treatment and all patients received anticoagulation therapy. Except the patient without cancer related treatment who survived for 3 months, all the other four patients survived more than 2 years.
Conclusion: Cancer can present as venous thromboembolism or arterial thromboembolism or both in advance. Cancer should be screened in patients with venous thromboembolism, especially those with concomitant arterial thromboembolism.