Trousseau’s Syndrome Anticipating Lung Adenocarcinoma: A Combination of Novel Direct Oral Anticoagulant and Osimertinib to Treat It

Abstract

Trousseau’s syndrome was the unexpected manifestation of thrombotic events, often associated with the diagnosis of malignancies, since cancer has been recognized as a prothrombotic state. There is a wide experience using low molecular weight heparin or Fondaparinux, while the use of direct oral anticoagulants, as Rivaroxaban, had less extent. A 76-year-old woman was diagnosed by a Trousseau’s syndrome, with multiple arterial and venous thrombotic events, representing the alarm signals of an advanced non-small cell lung cancer (NSCLC). The patient’s burden of disease rapidly widespread, with unexpected and polidistrectual thrombotic events and an advanced NSCLC with pleural effusion carrying EGFR mutation. After the treatment with an inhibitor of activated Factor X, the thrombotic events did not stop. Starting new direct oral anticoagulant drug and the oral EGFR Tyrosine Kinase Inhibitor (TKI), according to the molecular features of lung cancer, she rapidly achieved good response on overall global burden of disease. The aim of this article was to report a case of Trousseau’s syndrome anticipating lung cancer diagnosis that was successfully treated with a quick start of proper anticoagulant and targeted oncological treatments. The interruption of thromboembolic events represented the first sign of disease response to treatments.