Platelet transfusion and anticoagulation in hematological cancer‐associated thrombosis and thrombocytopenia: The CAVEaT multicenter prospective cohort. (23rd May 2022)

• Record Type: Journal Article
• Authors: Booth, Stephen; Desborough, Michael; Curry, Nicola; Stanworth, Simon
• Other Names: Janum Sine investigator.; Todd Sophie investigator.; Bull Tom investigator.; Dunne Mary investigator.; Abeyrathna Shashi investigator.; Green Sarah investigator.; Doyle Andrew investigator.; Faruqi Uzma investigator.; Gyansah Cecilia investigator.; Roberts Lara investigator.; Wimalachandra Manujasri investigator.; Davis Sarah investigator.; Leary Heather investigator.; Chen Lucia investigator.; Bielby Hannah investigator.; Langridge Alexander investigator.; Pickard Kier investigator.; Willan John investigator.; Joffe Michael investigator.; Reddy Udaya investigator.; RajinderRaj Maya investigator.; Dhillon Elissa investigator.; Ejaz Ayesha investigator.; Challenor Sarah investigator.; Pickard Keir investigator.; Langridge Alexander investigator.; Zhao Rui investigator.; Nicolson Phillip LR investigator.; Syal Raghav investigator.; James Izabela investigator.; Abdolrazaghi Sina investigator.; Altohami Mohammed investigator.; Crosbie Nicola investigator.; Drysdale Elizabeth investigator.; Teasdale Lesley investigator.;
• Is Part Of: Journal of thrombosis and haemostasis. Volume 20:Number 8(2022)
• Page Start: 1830
• Page End: 1838
• Publication Date: 2022-05-23
• Subjects: anticoagulants -- hematologic neoplasms -- platelet transfusion -- thrombocytopenia -- thrombosis; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.15748
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract: Background: Venous thromboembolism (VTE) in patients with thrombocytopenia represents a complex management challenge. Objectives: To describe practice, document outcomes, and compare management to national guidelines. Methods: We present a prospective multicenter cohort of 105 patients with hematological cancer, VTE within 28 days, and platelets <50 × 10 9 /L from May 14, 2019 to April 24, 2021 from 20 sites. Results: Median age was 64 and median initial platelet count 28 × 10 9 /L. Thromboses were: 46% catheter‐associated, 11% lower limb, 33% pulmonary emboli (PE), and 10% other sites. Management was according to International Society on Thrombosis and Haemostasis (ISTH) guidance in 30 (47%) of 64 patients with high‐risk thrombosis and 2 (5%) of low‐risk thrombosis (catheter‐associated or asymptomatic subsegmental PE). Twelve patients (11%) received no anticoagulation. At 28 days mortality was 15%, 8% experienced VTE progression, 7% experienced major bleeding, and 25% experienced clinically relevant non‐major bleeding. Four inferior vena cava filters were placed, two were later removed. The median number of platelet units transfused was 5 (range 0–53). Twenty‐seven percent of patients had a change of management strategy by 28 days. There was no clear relationship among platelet transfusion threshold, anticoagulant dose reduction threshold, and risk of thrombosis progression or major bleeding. Conclusions: This data set demonstrates the heterogeneity of approaches used in patients presenting with severe thrombocytopenia and acute thrombosis and confirms the high rates of bleeding in this cohort with thrombosis progression rates similar to the wider cancer‐associated thrombosis population. Randomized data is required to inform the optimal management.