Original article

Blood Transfusion - 3 2019 (May-June)

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

Authors

Key words: venous thrombosis, thrombocytopenia, blood cancer, anticoagulant treatment, consensus
Publication Date: 2018-10-24

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.

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Authors

Mariasanta Napolitano - Haematology Unit, Thrombosis and Haemostasis Reference Regional Center, University of Palermo, Palermo, Italy

Giorgia Saccullo - Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom

Marco Marietta - Haemostasis and Thrombosis Unit, Department of Haematology and Oncology, University Hospital of Modena, Modena, Italy

Monica Carpenedo - Haematology and Transplant Unit, A.O. "San Gerardo", University of Milan "Bicocca", Milan, Italy

Giancarlo Castaman - Centre for Bleeding Disorders and Coagulation, Department of Oncology, "Careggi" University Hospital, Florence, Italy

Elisabetta Cerchiara - Department of Haematology and Stem Cell Transplantation, "Campus Bio-Medico" University Hospital, Rome, Italy

Antonio Chistolini - Haematology Department, "Umberto I" Polyclinic Hospital, "La Sapienza" University of Rome Rome, Italy

Laura Contino - Haemostasis and Thrombosis Center, Haematology Unit, "SS Antonio e Biagio" Hospital, Alessandria, Italy

Valerio De Stefano - Institute of Haematology, Catholic University, "A. Gemelli" Academic Hospital, Rome, Italy

Anna Falanga - Department of Immunohematology and Transfusion Medicine and the Haemostasis and Thrombosis Center, "Papa Giovanni XXIII" Hospital, Bergamo, Italy

Augusto B. Federici - Haematology and Transfusion Medicine, "Luigi Sacco" University Hospital, Department of Oncology and Onco-Haematology, University of Milan, Milan, Italy

Elena Rossi - Institute of Haematology, Catholic University, "A. Gemelli" Academic Hospital, Rome, Italy

Rita Santoro - Haemostasis and Thrombosis Center, Onco-Haematology Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy

Sergio Siragusa - on behalf of the Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) Working Party on Thrombosis and Haemostasis Haematology Unit, Thrombosis and Haemostasis Reference Regional Center, University of Palermo, Palermo, Italy

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