This isn't crazy... this is good medicine!
I order Head CT's on cancer patients with newly diagnosed PE/DVT before anticoagulation if they have not had recent brain imaging (usually within the last month) regardless of any complaints or neuro findings. I think this is important as it could result in devastating consequences if the patient has asymptomatic mets and then receives blind anticoagulation.... These patients should really get IVC filters and not be anticoagulated. Additionally, what if your patient with a newly diagnosed DVT/PE decompensates or arrests in the ER ... or later in their hospital stay? Are you going to give that patient tPA??? I would rather know if they are a candidate for tPA up front. Once they code, it's too late to run them to the scanner....
If the head CT is negative for mets, I go ahead with anticoagulation.
If the head CT is positive for mets, I discuss it with a hematologist/oncologist before anticoagulation. I document my discussion including possibly withholding for IVC placement in the morning depending on type of cancer, size & number of mets, risk of ICH, and current hemodynamic status of the patient. And I inform the patient of the risk of intracranial hemorrhage with anticoagulation before intiating therapy, and make sure they are comfortable with this risk, and document that discussion as well.