Anticoagulation in cancer-associated thromboembolism with thrombocytopenia: a prospective, multicenter cohort study

• Type of Material: Article
• Authors: Brian J Carney, Beth Israel Deaconess Medical Center; Tzu-Fei Wang, University of Ottawa; Siyang Ren, Dana-Farber Cancer Institute; Gemlyn George, University of Colorado, Aurora; Amer Al Homssi, Medical College of Wisconsin; Manila Gaddh, Emory University; Gregory C Connolly, Rochester Regional Health; Vinay Shah, Henry Ford Hlth Syst; Thomas Bogue, Beth Israel Deaconess Medical Center; Abigail Bartosic, Ohio State University; Donna Neuberg, Dana-Farber Cancer Institute; Lisa Baumann Kreuziger, Versiti Blood Research Institute; Jeffrey I Zwicker, Beth Israel Deaconess Medical Center
• Language: English
• Date: 2021-12-20
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by The American Society of Hematology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2021005966
• Title of Journal or Parent Work: BLOOD ADVANCES
• Volume: 5
• Issue: 24
• Start Page: 5546
• End Page: 5553
• Keywords: THROMBOSIS; Science & Technology; Hematology; STRATEGIES; VENOUS-THROMBOEMBOLISM; GUIDELINES; VTE; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Oncology

Abstract

Venous thromboembolism (VTE) with concurrent thrombocytopenia is frequently encountered in patients with cancer. Therapeutic anticoagulation in the setting of thrombocytopenia is associated with a high risk of hemorrhage. Retrospective analyses suggest the utility of modified-dose anticoagulation in this population. To assess the incidence of hemorrhage or thrombosis according to anticoagulation strategy, we performed a prospective, multicenter, observational study. Patients with active malignancy, acute VTE, and concurrent thrombocytopenia (platelet count,100 000/mL) were enrolled. The cumulative incidences of hemorrhage or recurrent VTE were determined considering death as a competing risk. Primary outcomes were centrally adjudicated and comparisons made according to initial treatment with full-dose or modified-dose anticoagulation. A total of 121 patients were enrolled at 6 hospitals. Seventy-five patients were initially treated with full-dose anticoagulation (62%) and 33 (27%) with modified-dose anticoagulation; 13 (11%) patients received no anticoagulation. Most patients who received modified-dose anticoagulation had a hematologic malignancy (31 of 33 [94%]) and an acute deep vein thrombosis (28 of 33 [85%]). In patients who initially received full-dose anticoagulation, the cumulative incidence of major hemorrhage at 60 days was 12.8% (95% confidence interval [CI], 4.9-20.8) and 6.6% (95% CI, 2.4-15.7) in those who received modified-dose anticoagulation (Fine-Gray hazard ratio, 2.18; 95% CI, 1.21-3.93). The cumulative incidence of recurrent VTE at 60 days in patients who initially received full-dose anticoagulation was 5.6% (95% CI, 0.2-11) and 0% in patients who received modified-dose anticoagulation. In conclusion, modified-dose anticoagulation appears to be a safe alternative to therapeutic anticoagulation in patients with cancer who develop deep vein thrombosis in the setting of thrombocytopenia.