https://doi.org/10.4081/btvb.2024.115
Cancer complicated by thrombosis and thrombocytopenia: still a therapeutic dilemma
Submitted: 15 January 2024
Accepted: 5 April 2024
Published: 16 May 2024
Accepted: 5 April 2024
Abstract Views: 555
PDF: 180
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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.
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
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Most read articles by the same author(s)
- Kristen M. Sanfilippo, Tzu-Fei Wang, Venous thromboembolism and mortality in patients with hematological malignancies , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024): 12th ICTHIC
Similar Articles
- Armando Tripodi, The introduction of the international normalized ratio as a breakthrough event in the history of thrombosis , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 1 (2025)
- Paolo Prandoni, New perspectives for prevention of the post-thrombotic syndrome , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 1 (2022)
- Ezio Zanon, The intriguing association between cancer and congenital bleeding disorders , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 3 (2024)
- Cristina Legnani, Michela Cini, Sophie Testa, Alberto Tosetto, Claudia Dellanoce, Stefania Bellesso, Giuseppe Carli, Ilaria Nichele, Laura Lissandrini, Serena Zorzi, Emilia Antonucci, Gualtiero Palareti, Evaluation of Coaguchek®Pro II coagulation testing device performance to assess direct oral anticoagulant action. The DOAC-CHECK study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Armando Tripodi, Remembering the XXVI SISET Congress and the 50th anniversary of its foundation, 2020 , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 1 (2025)
- Giuseppe Auteri, Laura Ricci, Nicola Vianelli, Barbara Lovrencic, “Living under the sword of Damocles”: a psychological support project for patients with immune thrombocytopenia and their caregivers , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 1 (2025)
- Ilaria Nichele, Giuseppe Carli, Alberto Tosetto, Tailored therapy with turoctocog alfa pegol according to patient’s lifestyle and hemorrhagic phenotype: from clinical trial to real-life , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 1 (2024)
- Roberta Parisi, Simona Costanzo, Romy de Laat-Kremers, Augusto Di Castelnuovo, Amalia De Curtis, Teresa Panzera, Mariarosaria Persichillo, Chiara Cerletti, Giovanni de Gaetano, Maria Benedetta Donati, Licia Iacoviello, Bas de Laat , for the Moli-sani Study Investigators, Plasma fibrinogen levels and all-cause and cause-specific mortality in an Italian adult population: results from the Moli-sani study , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Giovanni de Gaetano, Artificial intelligence, platelets and aspirin , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 1 (2024)
- Giovanni Tiscia, Elvira Grandone, Talking about assisted reproductive techniques and thromboembolic risk: everything we always wanted to know , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
You may also start an advanced similarity search for this article.
