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Observational Study
. 2017 Nov;58(11):2573-2581.
doi: 10.1080/10428194.2017.1306644. Epub 2017 Apr 9.

Analysis of anticoagulation strategies for venous thromboembolism during severe thrombocytopenia in patients with hematologic malignancies: a retrospective cohort

Damon E Houghton  1 , Nigel S Key  1 , Neil A Zakai  2 , Jeffrey P Laux  3 , Thomas C Shea  1 , Stephan Moll  1
Affiliations
Observational Study

Analysis of anticoagulation strategies for venous thromboembolism during severe thrombocytopenia in patients with hematologic malignancies: a retrospective cohort

Damon E Houghton et al. Leuk Lymphoma. 2017 Nov.

Abstract

The safety and efficacy of anticoagulation for venous thromboembolism (VTE) at times of severe thrombocytopenia is unclear. In this retrospective study, we evaluated patients with hematologic malignancy and either (1) acute or chronic VTE on anticoagulation before platelet count dropped below 50 × 109/L or (2) acute VTE occurring while platelets were <50 × 109/L. In 78 eligible patients, the primary outcomes of time to recurrent VTE or clinically significant bleeding within 100 d were compared by management strategy. Bleeding occurred in 27% of patients receiving anticoagulation versus 3% when anticoagulation was held (IRR 10.1, 95% CI 1.5-432.6). Recurrent VTE occurred in 2% of patients receiving anticoagulation versus 15% when anticoagulation was held (IRR 0.17, 95% CI 0.0-1.51). Most bleeding occurred before day 31(11/13), but recurrent VTE mostly occurred after day 40 (5/6). Our findings suggest that temporarily withholding anticoagulation for VTE during severe thrombocytopenia in patients with hematologic malignancies might reduce adverse outcomes.

Keywords: Anticoagulation; hematologic malignancies; hemorrhage; thrombocytopenia; venous thromboembolism.

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Conflict of interest statement

Disclosure statement: The authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:
Flow diagram of selection criteria and follow-up
Figure 2:
Figure 2:
Time to event curves for (a) recurrent VTE, (b) clinically significant bleeding, and (c) composite outcome by anticoagulation management strategy.
Figure 2:
Figure 2:
Time to event curves for (a) recurrent VTE, (b) clinically significant bleeding, and (c) composite outcome by anticoagulation management strategy.
Figure 2:
Figure 2:
Time to event curves for (a) recurrent VTE, (b) clinically significant bleeding, and (c) composite outcome by anticoagulation management strategy.
Figure 3:
Figure 3:
Platelet Count and Anticoagulation Status at Time of Recurrent VTE or Bleeding Event. Abbreviations: AC=anticoagulation
See this image and copyright information in PMC

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