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Casey L. O’Connell and Howard A. Liebman

Venous thromboembolism (VTE) is a frequent clinical complication of cancer and its treatment. Although much of the epidemiologic data regarding this complication have been based on symptomatic events, the use of multidetector row CT scanner technology has led to increased identification of VTE on scans ordered primarily for staging or restaging of malignancy. These incidentally discovered VTEs are variously referred to in the literature as incidental, asymptomatic, unexpected, or unsuspected VTE. A recent guidance paper by the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis provided recommendations regarding this terminology (now termed incidental) and reporting of incidental VTE for clinical trials. A growing number of retrospective and case-controlled reports have described the prevalence, prognostic implications, and treatment options for these incidentally discovered VTE events, and have reported similar clinical outcomes for patients with incidental and symptomatic VTE. Because most reported patients with incidental VTE have been treated in a manner similar to those with symptomatic events, the present recommendations, except in rare circumstances, support the use of standard anticoagulation in the management of incidental deep vein thrombosis and pulmonary embolism.