Cancer Workup after Unprovoked Clot — Less Is More
Mené sur 854 patients présentant une maladie thromboembolique veineuse (durée de suivi : 1 an), cet essai multicentrique randomisé évalue l'efficacité d'une série d'examens médicaux en routine, comportant une tomographie numérique de l'abdomen et de la région pelvienne, pour détecter un cancer occulte
Consider this not unfamiliar scenario: a 56-year-old educator presents with sudden onset of swelling and pain in the right thigh. She has no coexisting conditions except for well-controlled hypertension and has no family history of thrombophilia. She is admitted to the hospital after compression ultrasonography reveals the presence of a femoral-vein thrombosis. There are no provoking factors such as recent surgery or hospitalization. The phrase “possible cancer” is brought up on rounds, despite the patient’s recent normal results on colonoscopy and mammography. The patient is anxious about undiagnosed cancer and asks whether extensive imaging to rule out cancer is needed.
New England Journal of Medicine , éditorial en libre accès, 2014