Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review
Background: Patients with cancer-associated thrombosis (CAT) are at an increased risk of recurrent thrombosis and bleeding, especially if there is treatment- or disease-related thrombocytopenia. While direct oral anticoagulants (DOACs) are used in the management of CAT, low molecular weight heparin...
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Elsevier
2025-01-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037925000081 |
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| author | Umaima Abbas Robin MacKenzie Ushra Khan Rija Fatima Tzu-Fei Wang Rong Luo Caroline Hamm Andrea Cervi |
| author_facet | Umaima Abbas Robin MacKenzie Ushra Khan Rija Fatima Tzu-Fei Wang Rong Luo Caroline Hamm Andrea Cervi |
| author_sort | Umaima Abbas |
| collection | DOAJ |
| description | Background: Patients with cancer-associated thrombosis (CAT) are at an increased risk of recurrent thrombosis and bleeding, especially if there is treatment- or disease-related thrombocytopenia. While direct oral anticoagulants (DOACs) are used in the management of CAT, low molecular weight heparin (LMWH) continues to be recommended for CAT with thrombocytopenia. Objectives: This study aimed to identify the rates of recurrent venous thromboembolism (VTE) and bleeding in patients with CAT and thrombocytopenia treated with DOACs compared with LMWH. Methods: A retrospective review of patients with CAT and thrombocytopenia (platelet count <100,000/μL) was conducted. Primary outcomes included rates of recurrent VTE and major bleeding over 90 days. Results: Forty-two patients met the inclusion criteria; 20 (47.6%) had a solid organ malignancy while 22 (52.4%) had a hematologic malignancy. Within the first 7 days of VTE, 3 (7.1%) patients had a platelet count <25,000/μL, 9 (21.4%) had 25,000 to 50,000/μL, and 19 (45.2%) had 50,000 to 100,000/μL. Sixteen patients (38.1%) received a DOAC for initial treatment, while 19 (45.2%) received LMWH. Among patients treated with DOACs, there were no recurrent VTEs, 2 clinically relevant nonmajor bleeding events (12.5%) within the first 2 weeks, and 1 minor bleed (6.3%) in the second month, while those treated with LMWH had 1 recurrent VTE (5.3%) in the second month and 2 clinically relevant nonmajor bleeding events (10.5%) within the first 2 months. Conclusion: Rates of thrombosis and major bleeding were similar among thrombocytopenic patients with CAT treated with DOACs and LMWH, although differences in baseline patient characteristics can be confounders. Further prospective research on the optimal anticoagulant management of CAT with thrombocytopenia is needed. |
| format | Article |
| id | doaj-art-7bd6ee919001437e9d5f19ce44e743fc |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-7bd6ee919001437e9d5f19ce44e743fc2025-02-06T05:12:39ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792025-01-0191102684Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart reviewUmaima Abbas0Robin MacKenzie1Ushra Khan2Rija Fatima3Tzu-Fei Wang4Rong Luo5Caroline Hamm6Andrea Cervi7Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, CanadaDepartment of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, CanadaDepartment of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, CanadaDepartment of Translational Health Science, University of Windsor, Windsor, Ontario, CanadaDepartment of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Mathematics and Statistics, Leddy Library, University of Windsor, Windsor, Ontario, CanadaDepartment of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada; Department of Oncology, Windsor Regional Hospital, Windsor, Ontario, CanadaDepartment of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada; Department of Oncology, Windsor Regional Hospital, Windsor, Ontario, Canada; Correspondence Andrea L. Cervi, Windsor Regional Cancer Program, 1995 Lens Avenue, Windsor, ON N8W 2X3, Canada.Background: Patients with cancer-associated thrombosis (CAT) are at an increased risk of recurrent thrombosis and bleeding, especially if there is treatment- or disease-related thrombocytopenia. While direct oral anticoagulants (DOACs) are used in the management of CAT, low molecular weight heparin (LMWH) continues to be recommended for CAT with thrombocytopenia. Objectives: This study aimed to identify the rates of recurrent venous thromboembolism (VTE) and bleeding in patients with CAT and thrombocytopenia treated with DOACs compared with LMWH. Methods: A retrospective review of patients with CAT and thrombocytopenia (platelet count <100,000/μL) was conducted. Primary outcomes included rates of recurrent VTE and major bleeding over 90 days. Results: Forty-two patients met the inclusion criteria; 20 (47.6%) had a solid organ malignancy while 22 (52.4%) had a hematologic malignancy. Within the first 7 days of VTE, 3 (7.1%) patients had a platelet count <25,000/μL, 9 (21.4%) had 25,000 to 50,000/μL, and 19 (45.2%) had 50,000 to 100,000/μL. Sixteen patients (38.1%) received a DOAC for initial treatment, while 19 (45.2%) received LMWH. Among patients treated with DOACs, there were no recurrent VTEs, 2 clinically relevant nonmajor bleeding events (12.5%) within the first 2 weeks, and 1 minor bleed (6.3%) in the second month, while those treated with LMWH had 1 recurrent VTE (5.3%) in the second month and 2 clinically relevant nonmajor bleeding events (10.5%) within the first 2 months. Conclusion: Rates of thrombosis and major bleeding were similar among thrombocytopenic patients with CAT treated with DOACs and LMWH, although differences in baseline patient characteristics can be confounders. Further prospective research on the optimal anticoagulant management of CAT with thrombocytopenia is needed.http://www.sciencedirect.com/science/article/pii/S2475037925000081direct oral anticoagulanthemorrhageneoplasmsthrombocytopeniavenous thromboembolism |
| spellingShingle | Umaima Abbas Robin MacKenzie Ushra Khan Rija Fatima Tzu-Fei Wang Rong Luo Caroline Hamm Andrea Cervi Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review Research and Practice in Thrombosis and Haemostasis direct oral anticoagulant hemorrhage neoplasms thrombocytopenia venous thromboembolism |
| title | Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review |
| title_full | Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review |
| title_fullStr | Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review |
| title_full_unstemmed | Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review |
| title_short | Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review |
| title_sort | anticoagulant management of cancer associated thrombosis and thrombocytopenia a retrospective chart review |
| topic | direct oral anticoagulant hemorrhage neoplasms thrombocytopenia venous thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2475037925000081 |
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