Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes

Abstract

BACKGROUND.Patients with cancer who have thrombocytopenia may experience acute coronary syndromes (ACS), and the use of aspirin (ASA) poses an increased risk of bleeding. The purpose of this study was to test the hypothesis that the benefit of ASA therapy in the treatment of ACS would extend to cancer patients with thrombocytopenia and outweigh the risks of severe bleeding.METHODS.The records of all cancer patients diagnosed with an ACS in 2001 and referred for cardiology consultation were reviewed. Patients were divided into 2 groups on the basis of platelet count, >100 cells k/μL and ≤100 cells k/μL. Data were collected on the use of ASA therapy, bleeding complications, and survival rates. The authors assessed group differences by using the Wilcoxon rank sum test or 2‐tailed Fisher exact test, as appropriate. Univariate and multivariate logistic regression models were used to assess factors potentially associated with 7‐day survival.RESULTS.In cancer patients with ACS and thrombocytopenia, those who did not receive ASA had a 7‐day survival rate of 6% compared with 90% in those who did receive ASA (P < .0001). There were no severe bleeding complications. Patients with a platelet count (>100 cells k/μL) who received ASA had a 7‐day survival rate of 88% compared with 45% in those who did not receive ASA (P = .0096).CONCLUSIONS.Therapy with ASA was associated with a significantly improved 7‐day survival after ACS in cancer patients, with or without thrombocytopenia, and not associated with more severe bleeding. Cancer 2007;109:621–627. © 2006 American Cancer Society.

Cardiovascular complications of chemotherapy: A synopsis

“…In a retrospective study in patients with thrombocytopaenia, aspirin improved the outcome without increasing the risk of bleeding. (34) …”

I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia

“…A síndrome coronariana aguda (SCA) resulta da interação entre a lesão aterosclerótica e o sistema hematopoiético, gerando ruptura de uma placa vulnerável ou erosão da placa com formação de um trombo, que pode ocluir a luz vascular parcialmente (angina/infarto agudo do miocárdio sem supradesnivelamento do segmento ST) ou totalmente (infarto agudo do miocárdio com supradesnivelamento do segmento ST) 89,90 . A apresentação clínica da doença coronária nos pacientes com câncer é semelhante à observada na população geral.…”

Analysis of the costs and quality of cardiovascular care in oncological monitoring

“…It has been noted that the main events occur due to the association of risks for atherosclerotic disease with higher incidence of thrombogenicity, coagulopathy and thrombocytopenia. 7,[12][13][14][15][16][17] Other manifestations of cardiotoxicity related to cancer treatment include valve changes, arrhythmias (atrial fibrillation and prolonged QTc being the most frequent), hypertension, and pericarditis. 7,18,19 Cardiotoxicity related to cancer treatment may become manifest at any time, with reports of it occurring within 45 years or more after the end of treatment.…”