https://doi.org/10.4081/btvb.2024.115

Cancer complicated by thrombosis and thrombocytopenia: still a therapeutic dilemma

Vol. 3 No. s1 (2024): 12th ICTHIC
Submitted: 15 January 2024
Accepted: 5 April 2024
Published: 16 May 2024
Cancer-associated thrombosis, thrombocytopenia
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PDF: 91
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Authors

Yishi Tan
Department of Haematology, University College London Hospital; Institute of Cardiovascular Science, University College London, United Kingdom.
Marc Carrier
Division of Hematology, Department of Medicine, University of Ottawa, Ottawa Hospital, ON, Canada.
Nicola Curry
Department of Haematology, Oxford University Hospitals NHS Foundation Trust; Radcliffe Department of Medicine, University of Oxford, United Kingdom.
Michael Desborough
Department of Haematology, Oxford University Hospitals NHS Foundation Trust; Radcliffe Department of Medicine, University of Oxford, United Kingdom.
Kathryn Musgrave
Department of Haematology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
Marie Scully
Department of Haematology, University College London Hospital; Institute of Cardiovascular Science, University College London, United Kingdom.
Tzu-Fei Wang
Division of Hematology, Department of Medicine, University of Ottawa, Ottawa Hospital, ON, Canada.
Mari Thomas
Department of Haematology, University College London Hospital; Institute of Cardiovascular Science, University College London, United Kingdom.
Simon J. Stanworth
simon.stanworth@nhsbt.nhs.uk
https://orcid.org/0000-0002-7414-4950
Department of Haematology, Oxford University Hospitals NHS Foundation Trust; Radcliffe Department of Medicine, University of Oxford; NHSBT, Oxford, United Kingdom.

Individuals who have thrombocytopenia and cancer-associated thrombosis (CAT) are difficult to manage because they have a high risk of bleeding and recurrent thrombosis. The International Society on Thrombosis and Haemostasis guidelines for the management of thrombocytopenia in patients with CAT suggest two main approaches: either complete anticoagulation with transfusion support if necessary, or dose-modified anticoagulation while the platelet count is <50×109/L. Nevertheless, rather than being based on information from randomized controlled trials (RCTs), these recommendations were based on expert consensus. Recent research from two different countries has shown how this cohort’s management and results vary widely. While the United Kingdom study, Cancer-Associated Venous Thrombosis and Thrombocytopenia, found no significant differences in bleeding or recurrent thrombosis between full dose and modified dose groups, the North American Thrombocytopenia Related Outcomes with Venous thromboembolism study demonstrated a significantly lower risk of bleeding events in those receiving modified dose anticoagulation compared to full dose, without an increased risk of recurrent VTE. Therefore, an RCT is required to assess the best course of action for patients with CAT and thrombocytopenia. To define the standard of care for the management of patients with CAT and thrombocytopenia, a full-scale trial called the START randomized trial (STrategies for Anticoagulation in patients with thRombocytopenia and cancer-associated Thrombosis) is an international, multi-site pilot study that compares the use of platelet transfusions plus higher dose anticoagulation to modified dose anticoagulation in patients with thrombocytopenia and CAT receiving anticoagulation.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Liebman HA. Thrombocytopenia in cancer patients. Thromb Res 2014;133:S63-9. DOI: https://doi.org/10.1016/S0049-3848(14)50011-4
Slichter SJ, Kaufman RM, Assmann SF, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med 2010;362:600-13. DOI: https://doi.org/10.1056/NEJMoa0904084
Samuelson Bannow BR, Lee AYY, Khorana AA, et al. Management of anticoagulation for cancer-associated thrombosis in patients with thrombocytopenia: a systematic review. Res Pract Thromb Haemost 2018;2:664-9. DOI: https://doi.org/10.1002/rth2.12111
Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer incidence and mortality projections in the UK until 2035. Br J Cancer 2016;115:1147-55. DOI: https://doi.org/10.1038/bjc.2016.304
Falanga A, Marchetti M. Cancer-associated thrombosis: enhanced awareness and pathophysiologic complexity. J Throm Haemost 2023;21:1397-408. DOI: https://doi.org/10.1016/j.jtha.2023.02.029
Mulder FI, Horváth-Puhó E, van Es N, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021;137:1959-69. DOI: https://doi.org/10.1182/blood.2020007338
Farge D, Frere C, Connors JM, et al. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 2019;20:e566-81. DOI: https://doi.org/10.1016/S1470-2045(19)30750-8
Hsu C, Patell R, Zwicker JI. The prevalence of thrombocytopenia in patients with acute cancer-associated thrombosis. Blood Adv 2023;7:4721-7. DOI: https://doi.org/10.1182/bloodadvances.2022008644
Pegourie B, Karlin L, Benboubker L, et al. Apixaban for the prevention of thromboembolism in immunomodulatory treated myeloma patients: Myelaxat, a phase 2 pilot study. Am J Hematol 2019;94:635-40. DOI: https://doi.org/10.1002/ajh.25459
De Stefano V, Sorà F, Rossi E, et al. The risk of thrombosis in patients with acute leukemia: Occurrence of thrombosis at diagnosis and during treatment. J Throm Haemost 2005;3: 1985-92. DOI: https://doi.org/10.1111/j.1538-7836.2005.01467.x
Kekre N, Connors JM. Venous thromboembolism incidence in hematologic malignancies. Blood Rev 2019;33:24-32. DOI: https://doi.org/10.1016/j.blre.2018.06.002
Gerber DE, Segal JB, Yair Levy M, et al. The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention. Blood 2008;112:504-10. DOI: https://doi.org/10.1182/blood-2007-10-117051
Khorana A, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-7. DOI: https://doi.org/10.1182/blood-2007-10-116327
Mulder FI, Candeloro M, Kamphuisen PW, et al. The Khorana score for prediction of venous thromboembolism in cancer patients: a systematic review and meta-analysis. Haematologica 2019;104:1277-87. DOI: https://doi.org/10.3324/haematol.2018.209114
Wang TF, Carrier M, Carney BJ, et al. Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: a systematic review and meta-analysis. Thromb Res 2023;227:8-16. DOI: https://doi.org/10.1016/j.thromres.2023.05.012
Sørensen HT, Mellemkjær L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. New Eng J Med 2000;343:1846-50. DOI: https://doi.org/10.1056/NEJM200012213432504
Cohen AT, Katholing A, Rietbrock S, et al. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer: a population-based cohort study. Thromb Haemost 2017;117:57-65. DOI: https://doi.org/10.1160/TH15-08-0686
Samuelson Bannow BT, Lee A, Khorana AA, et al. Management of cancer-associated thrombosis in patients with thrombocytopenia: guidance from the SSC of the ISTH. J Thromb Haemost 2018;16:1246-9. DOI: https://doi.org/10.1111/jth.14015
Estcourt LJ, Birchall J, Allard S, et al. Guidelines for the Use of Platelet Transfusions A British Society for Haematology Guideline. Available from: https://b-s-h.org.uk/media/2641/bcsh_platelet_guideline_08_08_16_v2.pdf (cited 2023 Jun 15)
Curley A, Stanworth SJ, Willoughby K, et al. Randomized Trial of platelet-transfusion thresholds in neonates. New Eng J Med 2019;380:242-51. DOI: https://doi.org/10.1056/NEJMoa1807320
Baharoglu MI, Cordonnier C, Salman RAS, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016;387:2605-13. DOI: https://doi.org/10.1016/S0140-6736(16)30392-0
Carrier M, Blais N, Crowther M, et al. Treatment algorithm in cancer-associated thrombosis: updated Canadian expert consensus. Curr Oncol 2021;28:5434-51. DOI: https://doi.org/10.3390/curroncol28060453
Carney BJ, Wang TF, Ren S, et al. Anticoagulation in cancer-associated thromboembolism with thrombocytopenia: a prospective, multicenter cohort study. Blood Adv 2021;5: 5546-53. DOI: https://doi.org/10.1182/bloodadvances.2021005966
Booth S, Desborough M, Curry N, et al. Platelet transfusion and anticoagulation in hematological cancer-associated thrombosis and thrombocytopenia: The CAVEaT multicenter prospective cohort. J Thromb Haemost 2022;20:1830-8. DOI: https://doi.org/10.1111/jth.15748

How to Cite

Tan, Y., Carrier, M., Curry, N., Desborough, M., Musgrave, K., Scully, M., … Stanworth, S. J. (2024). Cancer complicated by thrombosis and thrombocytopenia: still a therapeutic dilemma. Bleeding, Thrombosis and Vascular Biology, 3(s1). https://doi.org/10.4081/btvb.2024.115
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