Patients treated for acute VTE during periods of treatment-related thrombocytopenia have high rates of recurrent thrombosis and transfusion-related adverse outcomes
- 169 Downloads
Venous thromboembolism (VTE) is a common complication of hematologic malignancies. Prolonged periods of thrombocytopenia are experienced universally by patients undergoing treatment for these diseases, yet data to guide management of anticoagulation in this setting are lacking. To obtain data on the management and outcomes of VTE in patients with thrombocytopenia related to the treatment of hematologic malignancies. This was an observational cohort study of patients experiencing VTE during periods of treatment-related thrombocytopenia over a 5-year period at the Fred Hutchinson Cancer Research Center. Medical records were reviewed for diagnostic, treatment and outcomes data, including bleeding events (categorized by WHO criteria) and progression or recurrence of VTE. Eighty-two patients meeting inclusion criteria were identified. Forty-eight percent were male and the median age was 55. Sixty-seven patients received anticoagulation, 88% of these were managed with transfusion support for a platelet goal of 50 × 109/L. Thirty-one patients experienced bleeding events, 22 of which were grade 2 and nine of which were grade 3/4. The median platelet count at the time of bleeding event was 54 × 109/L. Seven patients experienced progression of thrombosis and/or recurrence. Eleven patients experienced transfusion reactions and 30 experienced volume overload requiring diuretics or dialysis. While bleeding events were not uncommon, the majority of events were non-major/non-clinically relevant. Most bleeding events occurred while the platelet count was within the ‘goal’ range of ≥50 × 109/L, and many patients experienced transfusion related adverse events. Prospective studies are urgently needed to identify the optimal transfusion strategy for these patients.
KeywordsVenous thromboembolism Thromboembolism, pulmonary Hematologic neoplasms Platelet transfusion Hemorrhage
This research was supported (in part) by the NHLBI under award number T32HL007093.
Compliance with ethical standards
Conflict of interest
The authors have no relevant conflicts of interest to report.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
A waiver of informed consent was granted by the IRB (based upon lack of direct patient contact, minimal risk and inability to contact many subjects due to death or other circumstances).
- 1.Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, Gernsheimer TB, Ness PM, Brecher ME, Josephson CD, Konkle BA, Woodson RD, Ortel TL, Hillyer CD, Skerrett DL, McCrae KR, Sloan SR, Uhl L, George JN, Aquino VM, Manno CS, McFarland JG, Hess JR, Leissinger C, Granger S (2010) Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med 362:600–613. doi: 10.1056/NEJMoa0904084 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Gerber DE, Segal JB, Levy MY, Kane J, Jones RJ, Streiff MB (2008) The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention. Blood 112:504–510. doi: 10.1182/blood-2007-10-117051 CrossRefPubMedGoogle Scholar
- 3.Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M (2003) Randomized comparison of low-molecular-weight heparin versus oral anticoagulant therapy for the prevention of recurrent venous thromboembolism in patients with cancer I. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146–153. doi: 10.1056/NEJMoa025313 CrossRefPubMedGoogle Scholar
- 4.Lee AY, Bauersachs R, Janas MS, Jarner MF, Kamphuisen PW, Meyer G, Khorana AA, Investigators C (2013) CATCH: a randomised clinical trial comparing long-term tinzaparin versus warfarin for treatment of acute venous thromboembolism in cancer patients. BMC Cancer 13:284. doi: 10.1186/1471-2407-13-284 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Lee AY, Kamphuisen PW, Meyer G, Bauersachs R, Janas MS, Jarner MF, Khorana AA, Investigators C (2015) Tinzaparin vs Warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA 314:677–686. doi: 10.1001/jama.2015.9243 CrossRefPubMedGoogle Scholar
- 8.Carrier M, Khorana AA, Zwicker J, Noble S, Lee AY, Subcommittee on Haemostastis and Malignancy for the SSC of the ISTH (2013) Management of challenging cases of patients with cancer-associated thrombosis including recurrent thrombosis and bleeding: guidance from the SSC of the ISTH. J Thromb Haemost 11:1760–1765. doi: 10.1111/jth.12338 CrossRefPubMedGoogle Scholar