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Review
. 2019 May;17(3):171-180.
doi: 10.2450/2018.0143-18. Epub 2018 Oct 24.

Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: an expert consensus

Mariasanta Napolitano  1 , Giorgia Saccullo  2 , Marco Marietta  3 , Monica Carpenedo  4 , Giancarlo Castaman  5 , Elisabetta Cerchiara  6 , Antonio Chistolini  7 , Laura Contino  8 , Valerio De Stefano  9 , Anna Falanga  10 , Augusto B Federici  11 , Elena Rossi  9 , Rita Santoro  12 , Sergio Siragusa  1 ; Gruppo Italiano Malattie EMatologiche dell’Adulto (GIMEMA) Working Party on Thrombosis and Hemostasis; Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) Working Party on Thrombosis and Haemostasis (see Appendix 1); Valerio De Stefano  13 , Anna Falanga  14 , Alberto Tosetto  15 , Giuseppe Avvisati  13 , Monica Carpenedo  16 , Augusto B Federici  16 , Marco Marietta  17 , Mariasanta Napolitano  18 , Elena Rossi  13 , Cristina Santoro  13 , Giancarlo Castaman  19 , Elisabetta Cerchiara  13 , Antonio Chistolini  13 , Laura Contino  20 , Maria Gabriella Mazzucconi  13 , Ilaria Nichele  15 , Laura Russo  14 , Roberto Santi  20 , Rita Carlotta Santoro  21 , Sergio Siragusa  18 , Giuseppe Tagariello  22
Affiliations
Review

Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: an expert consensus

Mariasanta Napolitano et al. Blood Transfus. 2019 May.

Abstract

Background: Management of venous thromboembolism (VTE) in patients with haematologic malignancies and thrombocytopenia is clinically challenging due to the related risks. No prospective studies or clinical trials have been carried out and, therefore, no solid evidence on this compelling issue is available.

Methods: Given this, an expert panel endorsed by the Gruppo Italiano Malattie Ematologiche dell'Adulto Working Party on Thrombosis and Haemostasis was set up to produce a formal consensus, according to the RAND method, in order to issue clinical recommendations about the platelet (PLT) cut-off for safe administration of low molecular weight heparin (LMWH) in thrombocytopenic (PLT <100×109/L) adult patients with haematologic malignancies affected by acute (<1 month) or non-acute VTE.

Results: In acute VTE, the panel suggests safe anticoagulation with LMWH at therapeutic doses for PLT between ≥50<100×109/L and at 50% dose reduction for PLT ≥30<50×109/L. In acute VTE for PLT <30×109/L, the following interventions are recommended: positioning of an inferior vena cava (IVC) filter with prophylactic LMWH administration and platelet transfusion. In non-acute VTE, anticoagulation with LMWH at therapeutic doses for PLT between ≥50<100×109/L or over and at 50% dose reduction for PLT ≥30<50×109/L is considered appropriate. The discontinuation of full or reduced therapeutic dose of LMWH is recommended for PLT <30×109/L, both in acute and non-acute VTE.

Discussion: We suggest using dose-adjusted LMWH according to PLT to optimise anticoagulant treatment in patients at high bleeding risk.

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Conflict of interest statement

The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Summary of consensus steps according to the RAND method.
Figure 2
Figure 2
Summary of evaluated studies, according to the PRISMA Flow Diagnam.
See this image and copyright information in PMC

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