Venous thromboembolism in patients with hematologic malignancy and thrombocytopenia

Abstract

The optimal management of hematologic malignancy-associated venous thromboembolism (VTE) in patients with moderate-to-severe thrombocytopenia is unclear. This is a retrospective study of 128 adult patients with hematologic malignancies who were diagnosed with VTE. The outcome of patients with significant thrombocytopenia (≤50,000/µL) was compared with those without. Forty-seven patients (36.7%) had a platelet count ≤50,000/µL during a period of time of perceived need for new or continued anticoagulation. The median nadir platelet count in those with significant thrombocytopenia was 10,000/µL (range 2,000-45,000/µL) versus 165,000/µL (50,000-429,000/µL) in those without (P < 0.001). The median duration of significant thrombocytopenia in the first group was 10 days (1-35 days). Therapy during the period of significant thrombocytopenia included prophylactic-dose low-molecular-weight heparin (LMWH) (47%), therapeutic-dose LMWH or heparin (30%), warfarin (2%), inferior vena cava filter (2%), and observation (17%). Patients without thrombocytopenia were managed with the standard of care therapy. At a median follow-up of more than 2 years, the risk of clinically significant bleeding (11% vs 6%, P = 0.22) including major bleeding (6% vs 2%) and clot progression or recurrence (21% vs 22%, P = 1.00) were similar in patients with or without significant thrombocytopenia. In a multivariate analysis, the risk of recurrence/progression (hazard ratio, HR 0.59, 95% CI 0.21-1.66, P = 0.31) and hemorrhage rate (HR 0.29, 95% CI 0.05-1.56, P = 0.15) did not differ based on the presence of significant thrombocytopenia. Within the limits of this retrospective study, cautious use of prophylactic-dose LMWH may be safe in thrombocytopenic patients with hematologic malignancy-associated VTE. Am. J. Hematol. 91:E468-E472, 2016. © 2016 Wiley Periodicals, Inc.

Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

“…The patient with thrombocytopenia is another challenge, as clear-cut instructions and thresholds for the use of different agents are absent. Most clinicians would use the empirical cut off of 50,000/mm 3 for the administration of full LMWH administration and would half the dose for platelet counts between 49,000 and 30,000 mm 3 [103][104][105]. Based again on clinical experience, DOAC administration is considered safe at platelet counts of >50,000/mm 3 when the indication is treatment of VTE and at >75-80.000/µL when the indication is prophylaxis [106].…”

Management of cancer‐associated thrombosis in patients with thrombocytopenia: guidance from the SSC of the ISTH

“…Furthermore, prolonged thrombocytopenia (> 30 days) in patients with CAT is associated with a greater than four‐fold increased risk of recurrent venous thromboembolism (VTE) . The rates of bleeding in this population range from 7% to 33%, and the rates of recurrent thrombosis range from 10% to 44% . In 2013, the ISTH Scientific and Standardization Committee on Haemostasis and Malignancy released a guidance document addressing the management of challenging cases of patients with CAT, including CAT in the setting of thrombocytopenia .…”

“…Although a number of observational studies have reported on one management strategy or the other [11][12][13][14], only a handful of studies have reported data on several approaches. Unfortunately, randomized comparisons are not available, and clinicians are left with only retrospective case series and small, observational cohort studies to guide clinical decision-making [6,7,15]. A recent systematic review of the literature failed to identify any evidence for superiority of one method over another [16].…”

Reduced doses of direct oral anticoagulation are safe in atrial fibrillation patients with mild thrombocytopenia

“…ISSN: 2379-4550 http://digitalcommons.wayne.edu/crp, © 2019 The Author(s) 4 Licensed under Creative Commons Attribution Non-Commercial 4.0…”

“…This drug was not feasible for an outpatient, long-term use in our patient. 4 Aside from this critical appraisal's chosen publication, the Wang paper is the only other study examining anticoagulation in atrial fibrillation patients with thrombocytopenia. However, it is a retrospective cohort study assessing safety and efficacy of DOAC vs warfarin therapy in atrial fibrillation patients with thrombocytopenia.…”