Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: An expert consensus

Valerio De Stefano, Elena Rossi, Mariasanta Napolitano, Giorgia Saccullo, Marco Marietta, Monica Carpenedo, Giancarlo Castaman, Elisabetta Cerchiara, Antonio Chistolini, Laura Contino, Anna Falanga, Augusto B. Federici, Rita Santoro, Sergio Siragusa

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background. Management of venous thromboembolism (VTE) in patients with haematologic malignancies and thrombocytopenia is clinically challenging due to the related risks. No prospective studies or clinical trials have been carried out and, therefore, no solid evidence on this compelling issue is available. Methods. Given this, an expert panel endorsed by the Gruppo Italiano Malattie Ematologiche dell'Adulto Working Party on Thrombosis and Haemostasis was set up to produce a formal consensus, according to the RAND method, in order to issue clinical recommendations about the platelet (PLT) cut-off for safe administration of low molecular weight heparin (LMWH) in thrombocytopenic (PLT <100×109/L) adult patients with haematologic malignancies affected by acute (<1 month) or non-acute VTE. Results. In acute VTE, the panel suggests safe anticoagulation with LMWH at therapeutic doses for PLT between ≥50<100×109/L and at 50% dose reduction for PLT ≥30<50×109/L. In acute VTE for PLT <30×109/L, the following interventions are recommended: Positioning of an inferior vena cava (IVC) filter with prophylactic LMWH administration and platelet transfusion. In non-acute VTE, anticoagulation with LMWH at therapeutic doses for PLT between ≥50<100×109/L or over and at 50% dose reduction for PLT ≥30<50×109/L is considered appropriate. The discontinuation of full or reduced therapeutic dose of LMWH is recommended for PLT <30×109/L, both in acute and non-acute VTE. Discussion. We suggest using dose-adjusted LMWH according to PLT to optimise anticoagulant treatment in patients at high bleeding risk.
Original languageEnglish
Pages (from-to)171-180
Number of pages10
JournalBlood Transfusion
Volume17
DOIs
Publication statusPublished - 2019

Keywords

  • Anticoagulant treatment
  • Blood cancer
  • Consensus
  • Thrombocytopenia
  • Venous thrombosis

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