A 52-year-old-male patient with metastatic non-small-cell lung cancer and recurrent venous thromboembolism in unusual sites despite anticoagulation.

The link between cancer and venous thromboembolism is well known, with an annual incidence rate of venous thromboembolism between 0.5% and 20% depending on the primary site and background risk factors. Current guidelines suggest treatment with low-molecular-weight heparin over oral vitamin K antagonists. However, data regarding the management of recurrent venous thromboembolism when the patient is under treatment with anticoagulants are sparse. In this article we present a patient with multiple thromboembolic events in unusual sites despite anticoagulant treatment and we discuss the management options.