6533b7d6fe1ef96bd12657c0
RESEARCH PRODUCT
Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: an expert consensus
M NapolitanoG SacculloM MariettaM CarpenedoG CastamanE CerchiaraA ChistoliniL ContinoV De StefanoA FalangaAb FedericiE RossiR SantoroS Siragusasubject
venous thrombosis thrombocytopenia blood cancer anticoagulant treatment consensusanticoagulantsblood cancerblood plateletsvenous thromboembolismthrombocytopeniaHeparin Low-Molecular-Weightheparinplatelet countanticoagulant treatmentSettore MED/15 - MALATTIE DEL SANGUEVenous thromboembolism haematological malignancythrombocytopeniaconsensuslow-molecular-weightOriginal Articlehematologic neoplasmscardiovascular diseasesvenous thrombosishumansanticoagulant treatment; blood cancer; consensus; thrombocytopenia; venous thrombosis; anticoagulants; blood platelets; heparin low-molecular-weight; humans; platelet count; consensus; hematologic neoplasms; thrombocytopenia; venous thromboembolismAnticoagulant treatment; Blood cancer; Consensus; Thrombocytopenia; Venous thrombosisdescription
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
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-05-01 |