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Journal of Thrombosis and Thrombolysis

, Volume 44, Issue 4, pp 442–447 | Cite as

Patients treated for acute VTE during periods of treatment-related thrombocytopenia have high rates of recurrent thrombosis and transfusion-related adverse outcomes

  • B. T. Samuelson Bannow
  • R. B. Walter
  • T. B. Gernsheimer
  • D. A. Garcia
Article

Abstract

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.

Keywords

Venous thromboembolism Thromboembolism, pulmonary Hematologic neoplasms Platelet transfusion Hemorrhage 

Notes

Funding

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.

Ethical approval

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.

Informed consent

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).

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • B. T. Samuelson Bannow
    • 1
  • R. B. Walter
    • 2
  • T. B. Gernsheimer
    • 3
  • D. A. Garcia
    • 3
  1. 1.Fred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Fred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.Division of HematologyUniversity of WashingtonSeattleUSA

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