Acute Coronary Syndrome, Thrombocytopenia, and Antiplatelet Therapy in Critically Ill Cancer Patients

  • Teodora Donisan
  • Dinu Valentin Balanescu
  • Gloria Iliescu
  • Konstantinos Marmagkiolis
  • Cezar IliescuEmail author
Reference work entry


The management of acute coronary syndromes (ACS) in cancer patients may be complicated by cancer-related comorbidities, of which thrombocytopenia is common. Thrombocytopenic cancer patients are exposed to a simultaneous risk of both bleeding and thrombosis. Both antiplatelet regimens and invasive strategies for ACS have been shown to be safe in thrombocytopenic cancer patients. However, cancer patients are generally excluded from large, randomized cardiovascular trials. As a consequence, specific guidelines for the management of ACS in cancer patients, particularly in the setting of thrombocytopenia, are currently lacking. There are several important differences between the etiology and pathophysiology of ACS in cancer patients compared to the general population. These differences stem mainly from the prothrombotic state associated with malignancies and from the effect of anticancer therapies. Despite the proof of better survival in cancer patients with ACS treated with optimal medical therapy and invasive revascularization techniques, both are underused in this population. This chapter aims to present current data and available therapeutic strategies regarding ACS, thrombocytopenia, and antiplatelet therapy in critically ill cancer patients.


Acute coronary syndrome Antiplatelet therapy Cancer Cardio-oncology Coronary angiography Thrombocytopenia Percutaneous coronary intervention 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Teodora Donisan
    • 1
  • Dinu Valentin Balanescu
    • 1
  • Gloria Iliescu
    • 2
  • Konstantinos Marmagkiolis
    • 3
  • Cezar Iliescu
    • 1
    Email author
  1. 1.Department of CardiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of General Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Florida Hospital Pepin Heart InstituteTampaUSA

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