Management of anticoagulation for cancer-associated thrombosis in patients with thrombocytopenia: A systematic review

Bannow, B. Samuleson; Lee, A.Y.Y.; Khorana, Alok A.; Zwicker, Jeffrey I.; Noble, Simon; Ay, Cihan; Carrier, Marc

doi:10.1016/j.thromres.2018.02.054

Cited by 11 publications

(15 citation statements)

References 7 publications

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“…Lower thrombotic risk scenarios where full-dose anticoagulation may not be justified include non-acute VTE (especially in autologous hematopoietic stem cell transplantation), catheter-related thrombosis and low risk atrial fibrillation [ 114 , 125 , 126 , 129 ]. Strategies for mitigating the high bleeding risk associated with continued anticoagulation include increased platelet transfusion threshold (e.g., 40–50 × 10 9 /L) and anticoagulation dose reductions, but evidence proving the safety and efficacy of both approaches is lacking [ 130 ].…”

Section: Managing Antithrombotic Therapy In Thrombocytopenic Patiementioning

confidence: 99%

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Leader

Hofstetter

Spectre

2021

JCM

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Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

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Section: Managing Antithrombotic Therapy In Thrombocytopenic Patiementioning

confidence: 99%

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Leader

Hofstetter

Spectre

2021

JCM

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“…Multiple retrospective, single‐center cohort studies reported results on the management of CAT and thrombocytopenia, all with LMWH [34]. In general, regimens incorporated dose reduction or temporary holding of LMWH, depending on platelet count.…”

Section: Thrombocytopeniamentioning

confidence: 99%

Approach to Cancer-Associated Thrombosis: Challenging Situations and Knowledge Gaps

et al. 2020

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Malignancy is a significant risk factor for venous thromboembolism (VTE). It is estimated that up to 20% of patients with cancer may develop VTE at some time in their cancer journey. Cancer‐associated VTE can lead to hospitalizations, morbidity, delayed cancer treatment, and mortality. The optimal prevention and management of cancer‐associated thrombosis (CAT) is of utmost importance. Direct oral anticoagulants have been recommended as first‐line therapy for VTE treatment in the general population and their efficacy has recently been demonstrated in the cancer population, leading to increased use. However, patients with cancer have unique challenges and comorbidities that can lead to increased risks and concerns with anticoagulation. Herein we will discuss commonly encountered challenges in patients with CAT, review available literature, and provide practice suggestions. Implications for Practice This article aims to specifically address cancer‐associated thrombosis issues for which there is limited or absent evidence to guide best practice, for circumstances that pose unique challenges for clinicians, and for directions when the literature is conflicting. It reviews pertinent data for each selected topic and provides guidance for patient management based on the best available evidence and experiences from the panel.

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“…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 . A recent systematic review of the literature failed to identify any evidence for superiority of one method over another .…”

Section: Background and Available Evidencementioning

confidence: 99%

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

Bannow

Lee

Khorana

et al. 2018

Journal of Thrombosis and Haemostasis

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157

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Management of anticoagulation for cancer-associated thrombosis in patients with thrombocytopenia: A systematic review

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 11 publications

References 7 publications

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Approach to Cancer-Associated Thrombosis: Challenging Situations and Knowledge Gaps

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

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