Thromboembolic events in patients with malignant superior vena cava syndrome and the role of anticoagulation.

In patients with superior vena caval obstruction resulting from malignancy, the importance of vena caval thrombosis and the role of anticoagulation are incompletely understood. The authors discuss this aspect of the management of 25 patients with malignant superior vena cava syndrome. Ten patients were retrospectively reviewed after having been clinically diagnosed without venography, and treated without anticoagulation. Five thromboembolic complications occurred, two of which proved fatal. Fifteen patients were prospectively evaluated by angiography and then treated with anticoagulants. Angiographic evidence of intraluminal subclavian vein or superior vena caval thrombosis was found in five of these patients, and no thromboembolic complications occurred. Of the 20 patients ultimately anticoagulated, two fatal intracranial hemorrhages developed. The authors suggest the need for randomized prospective trials if the role of venography and anticoagulation in this syndrome is to be determined.