Antithrombotic medication in cancer-associated thrombocytopenia: Current evidence and knowledge gaps

A. Leader*, H. ten Cate, G. Spectre, E. A. M. Beckers, A. Falanga

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

In cancer patients, antithrombotic medications (i.e. anticoagulation or antiplatelet therapy) are frequently prescribed for prior or new indications such as venous thromboembolism or stoke prevention in atrial fibrillation. Balancing the risks of bleeding and thrombosis during periods of thrombocytopenia represents a significant challenge. Management is informed mainly by expert opinion and several recent retrospective studies on venous thromboembolism. The main management options include no change, temporarily withholding antithrombotic therapy, reducing dose, changing the regimen, and increasing the platelet transfusion threshold. Important recent advances in knowledge include the prognostic importance and apparent safety of aspirin in acute myocardial infarction and thrombocytopenia and data suggesting a low risk of recurrent venous thromboembolism in autologous stem cell transplantation patients who had anticoagulation withheld. This paper will review the literature on antithrombotic medication in thrombocytopenic patients with cancer. The significant knowledge gaps will be summarized and considerations for practice and research will be provided.

Original languageEnglish
Pages (from-to)76-88
Number of pages13
JournalCritical Reviews in Oncology/Hematology
Volume132
DOIs
Publication statusPublished - Dec 2018

Keywords

  • Anticoagulants
  • Arterial thrombosis
  • Bleeding
  • Neoplasms
  • Platelet aggregation inhibitors
  • Platelet transfusion
  • Thrombocytopenia
  • Venous thromboembolism
  • STEM-CELL-TRANSPLANTATION
  • ACUTE CORONARY SYNDROME
  • MOLECULAR-WEIGHT HEPARIN
  • PROPHYLACTIC PLATELET TRANSFUSIONS
  • RECURRENT VENOUS THROMBOEMBOLISM
  • ELEVATION MYOCARDIAL-INFARCTION
  • LOW-DOSE ASPIRIN
  • ATRIAL-FIBRILLATION
  • RISK-FACTORS
  • HEMATOLOGIC MALIGNANCIES

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