Safety of anticoagulation in the treatment of venous thromboembolism in patients with haematological malignancies and thrombocytopenia: Report of 5 cases and literature review

Lim, Ming Sheng; Enjeti, Anoop K

doi:10.1016/j.critrevonc.2016.06.011

Cited by 15 publications

(15 citation statements)

References 32 publications

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“…Patients were treated with full‐dose anticoagulation whatever the type of the thrombosis (PE, distal DVT [DDVT], proximal DVT [PDVT], and catheter‐related thrombosis). Similar observations have been made in some case series . Additionally, heparin was widely used as the first choice for anticoagulation treatment, and VTE treatment, in cancer patients .…”

supporting

confidence: 83%

Antithrombotic therapy and platelet transfusions in hematologic malignancy patients presenting chemotherapy‐induced thrombocytopenia: a French survey

Chalayer¹,

Cavalieri

Martignoles

et al. 2017

Transfusion

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BACKGROUND Patients with hematologic malignancies are at high risk for both thrombosis and bleeding. During the prolonged periods of thrombocytopenia experienced by patients who are receiving intensive chemotherapy, clinicians often hesitate to prescribe any protection against thrombosis. In case of anticoagulant prescription, it is the prescribers' responsibility to weigh risks and benefits for each patient. Current guidelines exist but do not take into account types of thrombosis, patients' comorbidities, or previous bleeding events. STUDY DESIGN AND METHODS We proposed to gain insight into hematologists' beliefs about antithrombotic prescription in hematologic malignancy patients, to design future clinical trials. Therefore, we conducted a survey in France to evaluate the practices among a panel of hematologists. RESULTS We found that more than 92% of the respondents prescribed therapeutic anticoagulation in case of pulmonary embolism or deep venous thrombosis. In the case of therapeutic anticoagulation, only 64% of the physicians reconsidered treatment under a platelet threshold of 50 × 109/L. None of the respondents decided to renounce treatment, nor to discontinue it because of thrombocytopenia, except in distal venous thrombosis or superficial vein thrombosis. One‐fifth of clinicians proposed the insertion of a vena cava filter. CONCLUSION As observed in the United States and Canada, we noticed discrepancies between recommendations and current practices in France. This highlights the urgent need to conduct studies to evaluate both efficacy and safety of antithrombotics in patients with hematologic cancer and thrombocytopenia.

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supporting

confidence: 83%

Antithrombotic therapy and platelet transfusions in hematologic malignancy patients presenting chemotherapy‐induced thrombocytopenia: a French survey

Chalayer¹,

Cavalieri

Martignoles

et al. 2017

Transfusion

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“…Of these, six were excluded for failing to include patients undergoing management according to both treatment strategies,6, 10, 11, 12, 13, 14 one was excluded for failure to report outcomes of both strategies7 and one was excluded for study design (case series of only five patients) 15. The remaining two studies were included and are described below.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining two studies were included and are described below. Ten studies which were excluded due to only utilizing one treatment strategy are outlined in Table 1 for comparison 12, 15, 16, 17, 18, 19, 20…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies which were excluded due to only utilizing one treatment strategy are outlined in Table 1 for comparison. 12,[15][16][17][18][19][20] Overall, 121 patients with CAT and thrombocytopenia were included in our review ( Table 2). Forty-two of these patients had pulmonary embolism (PE) and 87 had deep vein thrombosis (DVT) including 38 upper extremity DVT (several patients had multiple events at different locations).…”

Section: Resultsmentioning

confidence: 99%

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

Bannow

Lee

Khorana

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials The management of anticoagulation in patients with thrombocytopenia is controversial.Some studies suggest to administer reduced‐dose low‐molecular‐weight heparin (LMWH).While other studies suggest full‐dose anticoagulation using LMWH and transfusion support.The results from our systematic review do not support one management strategy over another. BackgroundThe management of anticoagulation for cancer‐associated thrombosis (CAT) in patients with thrombocytopenia is controversial. Whereas some studies suggest that administration of reduced‐dose low‐molecular‐weight heparin (LMWH) or temporary discontinuation for moderate and severe thrombocytopenia may be a safe and effective, others suggest full‐dose anticoagulation with transfusion support. We sought to address this important knowledge gap and summarize the literature comparing these two common management strategies.MethodsA systematic review of the literature (PROSPERO CRD42017077127) using MEDLINE (inception to September 2017) was conducted. We included studies that reported recurrent venous thromboembolism (VTE) and major bleeding complications among patients treated with both of the two most common management strategies: therapeutic anticoagulation with platelet transfusion support and dose‐modified anticoagulation for periods when the platelet count is <50 × 109/L.ResultsA total of 134 article records were identified on the initial search and 10 articles underwent full text review. Two observational studies met the inclusions criteria. A total of 121 patients with CAT and thrombocytopenia were included. Forty‐two of these patients had pulmonary embolism and 87 had deep vein thrombosis (DVT) including 38 upper extremity DVT. Overall, 27% of patients, regardless of their treatment strategy, experienced recurrent VTE. Thirteen percent of anticoagulated patients (15% of all patients) experienced a major bleeding episode. Meta‐analysis could not be conducted.ConclusionsOur findings do not support one management strategy over another to treat CAT patients with thrombocytopenia. However, the data highlights the heightened risk of recurrent VTE in this patient population despite the thrombocytopenia.

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“…69 There were 2 major bleeding events (1 fatal) and 1 minor bleed; there were no incidences of recurrent or new VTE. 69 Conversely, there were no major bleeds reported in a small retrospective study of 10 patients with haematological malignancies and thrombocytopenia undergoing intensive chemotherapy who received enoxaparin as thromboprophylaxis or for catheter-related central venous thrombosis. 70 As in the case series, during the period of severe thrombocytopenia, the enoxaparin dose was generally reduced.…”

Section: Special Populations At Increased Risk Of Bleeding Patients Wmentioning

confidence: 89%

Antithrombotic therapy for prophylaxis and treatment of venous thromboembolism in patients with cancer: review of the literature on current practice and emerging options

Kamphuisen

Agnelli

2017

ESMO Open

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The treatment of cancer-associated venous thromboembolism (VTE) is difficult because cancer patients with VTE on anticoagulation are at an increased risk of bleeding compared with patients without VTE. This review summarises the evidence supporting the current standard of care and emerging treatment options. In difficult-to-treat subpopulations, where clinical data are often lacking, this review also provides the best clinical practice strategies based on the available data. The use of therapeutic doses of parenteral anticoagulants in patients with cancer-associated VTE for at least 3 to 6 months is supported by the current clinical data. After major cancer surgery, extended thromboprophylaxis for approximately 1 month following hospital discharge is also supported. In select populations of ambulatory cancer patients with solid tumours, or in patients with myeloma receiving immunomodulatory agents in combination with chemotherapy and/or corticosteroids, pharmacological prophylaxis could be considered. Although parenteral anticoagulants may not be tolerated by some patients, the data pertaining to the use of direct oral anticoagulants (DOACs) in cancer patients with VTE at this point can only be considered hypothesis generating. Clarity of the use of DOACs is awaiting the results of head-to-head trials between DOACs and parenteral anticoagulants. In addition, because of the lack of clinical trials, there are still unanswered questions on the optimal treatment regimens in subpopulations at increased risk of bleeding, including cancer patients with thrombocytopenia and those with brain metastases. For clinicians to balance the risk of recurrent thrombosis with the chance of bleeding, they need to assess the relevant clinical data. Current data support the use of parenteral anticoagulants in cancer patients with VTE, but many unanswered questions pertaining to the optimal regimens in special subpopulations and regarding the efficacy and safety of DOACs remain. To address this need, there are currently several clinical trials under way.

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Safety of anticoagulation in the treatment of venous thromboembolism in patients with haematological malignancies and thrombocytopenia: Report of 5 cases and literature review

Cited by 15 publications

References 32 publications

Antithrombotic therapy and platelet transfusions in hematologic malignancy patients presenting chemotherapy‐induced thrombocytopenia: a French survey

Antithrombotic therapy and platelet transfusions in hematologic malignancy patients presenting chemotherapy‐induced thrombocytopenia: a French survey

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

Antithrombotic therapy for prophylaxis and treatment of venous thromboembolism in patients with cancer: review of the literature on current practice and emerging options

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