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Review
. 2022 Dec 9;2022(1):481-490.
doi: 10.1182/hematology.2022000384.

Thrombosis questions from the inpatient wards

George Goshua  1 , Pavan K Bendapudi  2 , Alfred Ian Lee  1
Affiliations
Review

Thrombosis questions from the inpatient wards

George Goshua et al. Hematology Am Soc Hematol Educ Program. .

Abstract

The multifaceted pathophysiologic processes that comprise thrombosis and thromboembolic diseases take on a particular urgency in the hospitalized setting. In this review, we explore 3 cases of thrombosis from the inpatient wards: purpura fulminans, cancer-associated thrombosis with thrombocytopenia, and coronavirus disease 2019 (COVID-19) and the use of dose-escalated anticoagulation therapy and antiplatelet agents. We discuss the evaluation and management of purpura fulminans and the roles of plasma transfusion, protein C and antithrombin replacement, and anticoagulation in treating this disease. We present a framework for evaluating the etiologies of thrombocytopenia in cancer and review 2 strategies for anticoagulation management in patients with cancer-associated thrombosis and thrombocytopenia, including recent prospective data supporting the use of dose-modified anticoagulation based on platelet count. Last, we dissect the major clinical trials of therapeutic- and intermediate-dose anticoagulation and antiplatelet therapy in hospitalized patients with COVID-19, reviewing key recommendations from consensus guidelines while highlighting ways in which institutional and patient-tailored practices regarding antithrombotic therapies in COVID-19 may differ. Together, the cases highlight the diverse and dramatic presentations of macro- and microvascular thrombosis as encountered on the inpatient wards.

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Conflict of interest statement

George Goshua: no competing financial interests to declare.

Pavan K. Bendapudi: no competing financial interests to declare.

Alfred Ian Lee: no competing financial interests to declare.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
(A) Retiform purpura, (B) bullous skin necrosis, (C) peripheral dusking, and (D) microvascular thrombosis in purpura fulminans. Adapted from Colling and Bendapudi (A, C, and D) and from Davis MDP et al.
Figure 1.
Figure 1.
(A) Retiform purpura, (B) bullous skin necrosis, (C) peripheral dusking, and (D) microvascular thrombosis in purpura fulminans. Adapted from Colling and Bendapudi (A, C, and D) and from Davis MDP et al.
Figure 1.
Figure 1.
(A) Retiform purpura, (B) bullous skin necrosis, (C) peripheral dusking, and (D) microvascular thrombosis in purpura fulminans. Adapted from Colling and Bendapudi (A, C, and D) and from Davis MDP et al.
Figure 1.
Figure 1.
(A) Retiform purpura, (B) bullous skin necrosis, (C) peripheral dusking, and (D) microvascular thrombosis in purpura fulminans. Adapted from Colling and Bendapudi (A, C, and D) and from Davis MDP et al.
Figure 2.
Figure 2.
Anticoagulation management in patients with CAT and thrombocytopenia. DOAC, direct oral anticoagulant; LMWH, low-molecular-weight heparin.
See this image and copyright information in PMC

References

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