title: Management and outcomes of cancer-associated venous thromboembolism in patients with concomitant thrombocytopenia: a retrospective cohort study.
abstract: Venous thromboembolism (VTE) and thrombocytopenia are both more common in cancer patients than in general populations. Both the outcomes and optimal management of cancer-associated VTE in thrombocytopenic patients are unknown. The objective of the current  study is to describe a cohort of patients presenting with acute cancer-associated VTE with concomitant thrombocytopenia, including management patterns and outcomes. We conducted a retrospective cohort study of all cancer patients admitted to a regional cancer centre and the main university hospital's hematology service in Edmonton, Alberta, from 2005-2011, who had thrombocytopenia at the time of acute VTE. We report rates of recurrent symptomatic thromboembolism, major and clinically relevant non-major bleeding, within the initial 3 months following VTE diagnosis. Seventy-four patients were identified as eligible and reviewed. Seventeen (23.0 %) patients did not receive any antithrombotic therapy, 30 (40.5 %) received a minimum of 3 months of full-dose anticoagulation, and 27 (36.5 %) received partial treatment, which was either dose-reduced, interrupted, or shortened in duration. Twenty-three (31.1 %) experienced recurrent thromboembolism and 13 (17.6 %) had bleeding events, of which 3 (4.1 %) were major. In conclusion, patients with acute cancer-associated VTE and concomitant thrombocytopenia were managed heterogeneously at our institution, without a predominant strategy. There was a high rate of short-term complications, including recurrent thromboembolism and hemorrhage in this cohort. Future research should focus on determining the optimal management strategy in this challenging clinical scenario.
authors.affiliation: Department of Medicine, Division of Hematology, University of Toronto, Princess Margaret Hospital, Room 5-616, 610 University Ave, Toronto, ON, Canada, M5T 2M9, Kopolovi@ualberta.ca.
authors.forename: Ilana
authors.initials: I
authors.lastname: Kopolovic
authors.forename: Agnes Y Y
authors.initials: AY
authors.lastname: Lee
authors.forename: Cynthia
authors.initials: C
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000150:complications* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight