Cancer and thrombosis

Expert: Stephan Rauh, Hospital Center Emile Mayrisch, Esch-sur-Alzette, Luxembourg Questions: 1- What would be your approach to patients for whom anticoagulation is of uncertain benefit, for example with active malignant disease in pelvis creating continuous venous compression and conditions for recurrent or progressive thrombosis? 2- In a cancer patient with creatinine clearance bellow 30 mcmol/ l what would be your anticoagulant of choice for the treatment of a tromboembolic event (DVT/PE)? 3- In a patient with a chemotherapy- induced trombocytopenia bellow 50 x 10^9/l and active PE  what would be your choice of LMWH? 4- Due to Covid pandemic there is a shortage of LMWHs  in our country. If LMWHs were  unavailable, what would be your first choice of alternative anticoagulant  for the prophylaxis or treatment of thromboembolic events in cancer patients? 5- In a premenopausal women diagnosed with estrogen receptor positive  high risk early breast cancer (node positive with more than 4 involved lymph nodes) with a high risk for thromboembolic events (history of thrombophilia) who opt for a pregnancy and do not tolerate LHRH analogs in combination with aromatase inhibitors? Would tamoxifen be an option with or w/o anticoagulant prophylaxis?