Platelet transfusion and tranexamic acid to prevent bleeding in outpatients with a hematological disease: A Dutch nationwide survey

Cornelissen, Loes L; Caram‐Deelder, Camila; Meier, Romy; Zwaginga, Jaap Jan; Evers, Dorothea

doi:10.1111/ejh.13555

Cited by 8 publications

(17 citation statements)

References 19 publications

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“… 4 , 5 , 6 , 7 The role of TXA as an adjunct to platelet transfusion in patients with thrombocytopenia with bone marrow failure was proposed many years ago, and on the basis of some early encouraging data, it was adopted by some centers as a standard of care. 8 , 9 However, until recently, no appropriately designed and adequately powered prospective study had formally addressed this topic. 10 …”

Section: Introductionmentioning

confidence: 99%

Absence of hyperfibrinolysis may explain lack of efficacy of tranexamic acid in hypoproliferative thrombocytopenia

et al. 2023

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The American Trial Using Tranexamic Acid (TXA) in Thrombocytopenia (A-TREAT, NCT02578901) demonstrated no superiority of TXA over placebo in preventing WHO grade 2 or higher bleeding in severely thrombocytopenic patients requiring supportive platelet transfusion following myeloablative therapy for hematologic disorders. In this ancillary study, we sought to determine whether this clinical outcome could be explained on the basis of correlative assays of fibrinolysis. Plasma was collected from A-TREAT participants (n=115) prior to initiation of study drug (baseline) and when TXA was at steady-state trough concentration (follow-up). Global fibrinolysis was measured by 3 assays: euglobulin clot lysis time (ECLT), plasmin generation (PG), and tPA-challenged clot lysis time (tPA-CLT). TXA was quantified in follow up samples by tandem mass spectrometry. Baseline samples did not demonstrate fibrinolytic activation by ECLT or tPA-CLT. Furthermore, neither ECLT nor levels of PAI-1, tPA, plasminogen, alpha2-antiplasmin or plasmin-antiplasmin complexes were associated with a greater risk of WHO grade 2+ bleeding. TXA trough concentrations were highly variable (range: 0.7-10 ug/ml) and did not correlate with bleeding severity, despite the fact that plasma TXA levels correlated strongly with pharmacodynamic assessments by PG (Spearman r, -0.78) or tPA-CLT (r, 0.74). We conclude: 1] No evidence of fibrinolytic activation was observed in these thrombocytopenic patients; 2] trough TXA concentrations varied significantly between patients receiving the same dosing schedule; and 3] tPA-CLT and PG correlated well with TXA drug levels.

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Section: Introductionmentioning

confidence: 99%

Absence of hyperfibrinolysis may explain lack of efficacy of tranexamic acid in hypoproliferative thrombocytopenia

et al. 2023

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“…A recent Dutch survey indicated that TXA is more commonly used for the control of bleeding in hematological malignancies than as prophylaxis [ 55 ], even though most studies of TXA were in the context of prophylaxis. There is currently scarce evidence supporting the use of this specific agent in this context.…”

Section: Managing Thrombocytopenia In Cancermentioning

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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“…In the past years, new laboratory tests have emerged that claim to be able to discriminate normal from abnormal hemostasis. In these new hemostatic assays the test methods and designs have shifted from: slow and time consuming tests to pointof-care tests 53 ; from testing a specific coagulation factor to testing more global hemostatic function 53,54 ; from plasma based testing to whole blood testing, taking into account the interaction of platelets, red blood cells and leukocytes 55,56 , and from a stirring/static test method to flow based testing 57,58 .…”

Section: New Hemostatic Testsmentioning

confidence: 99%

“…Examples of new tests are: whole blood impedance platelet aggregation (Multiplate) 59 , whole blood rotational thromboelastography (ROTEM or TEG) with various agonists including tPA-ROTEM 56,60 , thrombin generation 61 , multiparameter microfluidic assays 62 and flowcytometry 63 . In addition, there is an increasing focus on genetic testing like whole exome sequencing (WES) 64,65 .…”

Section: New Hemostatic Testsmentioning

confidence: 99%

“…Tranexamic acid is a lysine analogue and inhibits conversion of plasminogen to plasmin to slow down clot lysis. Results of a recent Dutch nationwide survey showed that tranexamic acid in CIT patients is predominantly prescribed as supportive care in case of a bleeding tendency or a clinically relevant bleeding in addition to platelet transfusion 56 .…”

Section: Future Perspectives (Part I)mentioning

confidence: 99%

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Diagnostics and mechanisms of hemostasis

Moenen

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Platelet transfusion and tranexamic acid to prevent bleeding in outpatients with a hematological disease: A Dutch nationwide survey

Cited by 8 publications

References 19 publications

Absence of hyperfibrinolysis may explain lack of efficacy of tranexamic acid in hypoproliferative thrombocytopenia

Absence of hyperfibrinolysis may explain lack of efficacy of tranexamic acid in hypoproliferative thrombocytopenia

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Diagnostics and mechanisms of hemostasis

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