FRCPath Haem Part 1 MCQs-Haemostasis 463

A 64-year-old woman is admitted for right hemicolectomy for a newly diagnosed caecal adenocarcinoma. Two weeks earlier, she developed a symptomatic proximal left femoral deep vein thrombosis (DVT), confirmed on compression ultrasonography. She was commenced on therapeutic LMWH and has remained clinically stable.

The colorectal surgeon plans surgery in 2 days' time and advises that therapeutic anticoagulation will need to be discontinued 24 hours before surgery because of the high bleeding risk. The operation cannot be delayed because of impending bowel obstruction. Renal function is normal.

Which ONE of the following is the most appropriate management?

A. Continue LMWH until the evening before surgery without interruption because recurrent VTE risk exceeds bleeding risk.

B. Stop LMWH and bridge with PROPHYLACTIC  low molecular weight heparin (LMWH), stopping LMWH 24 hours before surgery.

C. Insert a temporary (retrievable) inferior vena cava (IVC) filter before surgery, interrupt anticoagulation for surgery, and restart anticoagulation as soon as haemostasis permits, with planned filter retrieval.

D. Permanently discontinue anticoagulation and insert a permanent IVC filter because cancer is a persistent thrombotic risk factor.

E. Delay anticoagulation until after surgery because the DVT is already three weeks old and embolic risk is now negligible.