Patient With Lung Cancer Starting Chemotherapy
A 70-year-old man is seen for routine follow-up. He has a history of hypertension, hyperlipidemia, past tobacco use, and a history of superficial vein thrombosis. He was found to be Factor V Leiden heterozygous. He is obese with a body mass index of 36 kg/m2. His blood pressure and lipids are controlled on his current medications that include 81mg daily of aspirin for primary prevention. He was recently diagnosed with stage IIB non-small cell lung cancer. He completed surgery with negative margins. His oncologist plans to start adjuvant chemotherapy. Labs show a platelet count of 465x109/L, hemoglobin of 9.5 g/dL, a leukocyte value of 13.5x109/L. A comprehensive metabolic panel is normal. MRI brain scan was normal and without evidence of central nervous system metastases.
The patient is concerned about his risk of venous thromboembolism (VTE). Which of the following could be discussed as a strategy to reduce his risk?