The prevalence of thrombocytopenia in patients with acute cancer-associated thrombosis

Abstract

Introduction: Venous thromboembolism (VTE) and thrombocytopenia are frequently encountered complications in cancer patients. While there are several studies evaluating the safety and efficacy of anticoagulation regimens in patients with cancer associated thrombosis (CAT) with thrombocytopenia, there is a paucity of data assessing the scope of the concurrent diagnoses. This study evaluates the prevalence of thrombocytopenia among patients with acute CAT. Methods: A retrospective cohort analysis of adult cancer patients was conducted at Beth Israel Deaconess Medical Center between 2010 and 2021 with CAT (acute VTE within 6 months after new diagnosis of malignancy). VTE included acute deep vein thrombosis (DVT), pulmonary embolism (PE), abdominal or thoracic venous thrombosis, and cerebral sinus thrombosis (CST). The lowest platelet count within 2 weeks of (before or after) the index VTE event was identified to assess the frequency and grade of concurrent thrombocytopenia. Results: We identified 3,635 patients with CAT (79.8% solid tumors, 17.8% hematologic malignancies, and 2.4% multiple concurrent cancer diagnoses). Thrombocytopenia (defined as platelet count <100,000/µL) occurred in 22% (95% CI 21%-24%) of patients with CAT with solid tumors diagnoses and 47% (95% CI 43%-51%) of patients with CAT and hematologic malignancies. Severe thrombocytopenia (platelet count <50,000/µL) occurred in 7% (95% CI 6%-8%) of patients with solid tumors and 30% (95% CI 27%-34%) of patients with hematologic malignancies. Conclusions: Concurrent diagnoses of CAT and thrombocytopenia are very common, especially among patients with hematologic malignancies.

Decreased Platelet Reactivity and Function in a Mouse Model of Human Pancreatic Cancer

“…1 2 3 A recent study determined the rates of thrombocytopenia (<100,000/μL) and severe thrombocytopenia (<50,000/μL) in >3,500 patients with cancer-associated thrombosis. 4 Rates of thrombocytopenia for solid tumors and hematologic malignancies were 22 and 47%, respectively, and rates of severe thrombocytopenia for solid tumors and hematologic malignancies were 7 and 30%. 4 In addition, cancer patients with venous thromboembolism (VTE) receiving anticoagulant therapy have increased rates of VTE and major bleeding compared to a general population of VTE patients.…”

“…4 Rates of thrombocytopenia for solid tumors and hematologic malignancies were 22 and 47%, respectively, and rates of severe thrombocytopenia for solid tumors and hematologic malignancies were 7 and 30%. 4 In addition, cancer patients with venous thromboembolism (VTE) receiving anticoagulant therapy have increased rates of VTE and major bleeding compared to a general population of VTE patients. 5,6 Many studies have measured biomarkers of platelet activation including soluble P-selectin, soluble CD40 ligand, platelet factor 4 (PF4), and thrombospondin-1, in a variety of cancer patients.…”

Cellular Components Contributing to the Development of Venous Thrombosis in Patients with Pancreatic Cancer

“…76 On the contrary, concurrent thrombocytopenia and VTE occurs frequently in patients with solid cancers, 30% of the patients with gastrointestinal tumors and acute VTE was shown to have a platelet count below 100 × 10 9 /L. 77…”

The Role of Injectables in the Treatment and Prevention of Cancer-Associated Thrombosis

“…In that cohort, thrombocytopenia (platelets < 100,000/µL) occurred in 22% (95% CI, 21–24%) of patients with CAT and solid tumors and in 47% (95% CI, 43–51%) of patients with CAT and hematologic cancers. Severe thrombocytopenia (platelet < 50,000/µL) occurred in 7% (95% CI, 6–8%) and 30% (95% CI, 27–34%) of patients with solid/hematologic cancers, respectively [ 71 ]. In the case of hematologic malignancies, thrombocytopenia can be secondary to bone marrow infiltration by the leukemic blasts at disease onset or relapse or due to myelotoxic effects of antileukemia therapy [ 61 ].…”