Open AccessManagement of anticoagulation for cancer‐associated thrombosis in patients with thrombocytopenia: A systematic review
Author(s) -
Samuelson Bannow Bethany R.,
Lee Agnes Y. Y.,
Khorana Alok A.,
Zwicker Jeffrey I.,
Noble Simon,
Ay Cihan,
Carrier Marc
Publication year - 2018
Publication title -
research and practice in thrombosis and haemostasis
Language(s) - English
Resource type - Journals
ISSN - 2475-0379
DOI - 10.1002/rth2.12111
Subject(s) - medicine , discontinuation , thrombosis , pulmonary embolism , heparin induced thrombocytopenia , observational study , deep vein , low molecular weight heparin , population , venous thrombosis , heparin , platelet transfusion , medline , intensive care medicine , surgery , platelet , environmental health , political science , law
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.Background The 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. Methods A systematic review of the literature ( PROSPERO CRD 42017077127) 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 × 10 9 /L. Results A 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. Conclusions Our 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.