P420 A CANCER PATIENT WITH PULMONARY THROMBOEMBOLISM: IS IT RIGHT TO APPLY THE CRITERIA FOR DOSE REDUCTION IN THESE PATIENTS?

Abstract A 78 years old woman presented in our cardio–oncology out–patient clinic to renew apixaban treatment plan. In her medical history she was a former smoker, with chronic kidney disease IIIb stadium according KDIGOI guidelines creatinine of 1,54 mg/dl, GFR CKD 32 ml/min/1.73m2 and Cockcroft e Gault 28 ml/min/1.73m2. 2010, had right lobe pulmonary cancer diagnosis treated neo–adjuvant gemcitabine. After chemotherapy, underwent surgical lobectomy. During hospitalization deep venous thrombosis complicated by thromboembolism, heparin sc given resolution the clinical picture. 2012 recurrence thromboembolism. Heparin warfarin second time given. 2016 for progression, various oncological treatments found stability osimertinib stereotaxic radiotherapy. Warfarin switched low–doses low weight disease. 2021 therapy, under control. She continuing low–dose apixaban. One year later, CT scan demonstrated progression inferior cava thrombosis. cardiac evaluation unit required: patients asymptomatic. EKG Echocardiogram were normal. Apixaban dose changed edoxaban 30 mg. There complete vein recanalization. Unfortunately, patient died after 8 months cancer. It is important, direct oral anticoagulation therapy patient, consider not only indication reduction known registration studies but also factors.