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. 2024 Dec 24;8(24):6151-6160.
doi: 10.1182/bloodadvances.2024014249.

Impact of thrombocytopenia on bleeding and thrombotic outcomes in adults with cancer-associated splanchnic vein thrombosis

Michael Andersen Jr  1 , Maria J Fernandez Turizo  1 , Laura E Dodge  2   3 , Charles Hsu  4 , Kevin Barnum  5 , Jonathan Berry  5 , Jeffrey I Zwicker  4   6 , Rushad Patell  5
Affiliations

Impact of thrombocytopenia on bleeding and thrombotic outcomes in adults with cancer-associated splanchnic vein thrombosis

Michael Andersen Jr et al. Blood Adv. .

Abstract

Malignancy is a risk factor for splanchnic vein thrombosis (SpVT). Data on the natural history of cancer-associated SpVT are limited. This was a single-center, retrospective cohort study of 581 adult patients with cancer and SpVT. We aimed to characterize the impact of thrombocytopenia on major bleeding and progression or recurrence of SpVT within 1 year of an initial cancer-associated SpVT diagnosis. Baseline thrombocytopenia (platelet <100 × 103/μL within 15 days of SpVT diagnosis) was present in 39.5% of patients. A total of 39.2% of patients received therapeutic anticoagulation within 2 weeks of an SpVT diagnosis. The cumulative 1-year incidence of major bleeding was 10.7% (95% confidence interval [CI], 8.2-13.2) and 16.2% (95% CI, 13.2-19.2) for SpVT recurrence/progression. In the multivariable regression analysis, therapeutic anticoagulation was associated with increased major bleeding (adjusted risk ratio [aRR], 1.74; 95% CI, 1.08-2.81) and decreased progression/recurrence of SpVT (aRR, 0.55; 95% CI, 0.35-0.86). Baseline thrombocytopenia was not independently associated with either major bleeding (aRR, 0.76; 95% CI, 0.43-1.34) or progression/recurrence of SpVT (aRR, 1.14; 95% CI, 0.73-1.78). A secondary analysis using inverse probability of treatment weighting with propensity scores for baseline thrombocytopenia corroborated that patients with thrombocytopenia did not have an increased bleeding risk (adjusted hazard ratio [aHR], 0.81; 95% CI, 0.48-1.39). The multivariable analysis in which platelets were treated as a time varying covariate also did not reveal an association with major bleeding (aHR, 0.89; 95% CI, 0.55-1.45). Bleeding and thrombosis progression were frequent in patients with cancer-associated SpVT. Anticoagulation was associated with increased major bleeding and decreased thrombotic progression; thrombocytopenia did not impact the outcomes.

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Conflict of interest statement

Conflict-of-interest disclosure: J.I.Z. reports personal fees from Calyx, CSL Berhing, and Sanofi, and grants from Incyte and Quercegen outside the submitted work. R.P. reports personal fees from Merck Research outside the submitted work. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Cumulative incidence of bleeding outcomes. Cumulative incidence of (A) major bleeding and (B) CRNMB using the Kaplan-Meier method with death as a competing risk within 1 year of diagnosis of cancer-associated SpVT.
Figure 2.
Figure 2.
Cumulative incidence of thrombotic outcomes. Cumulative incidence of (A) progression/recurrence of SpVT and (B) usual-site VTE using the Kaplan-Meier method with death as a competing risk within 1 year of diagnosis of cancer-associated SpVT.
See this image and copyright information in PMC

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