Anyone who has performed brachytherapy for cervical cancer has likely encountered the conundrum of managing a concurrent thromboembolism. This practical review is here to provide guidance for balancing the need for both anticoagulation and invasive procedures. Highlights include considering anticoagulation even for superficial venous thrombosis as it is often a harbinger for deep venous thrombosis (DVT) in this population. For those with DVT, a CT pulmonary embolism protocol should also be assessed. For women on anticoagulation receiving brachytherapy, it can generally be continued throughout intracavitary procedures. Alternatively, holding anticoagulation is generally preferred for interstitial brachy and/or epidurals as well as actively bleeding tumors. The trickiest scenario is when the latter is paired with a high-risk for recurrent potentially fatal thromboembolic event. In this case, bridging with short-acting parenteral anticoagulant that can be held for the shortest time possible during brachy procedures is often warranted. | Brower, Pract Radiat Oncol 2025
