title: Venous thromboembolism in patients with hematologic malignancy and thrombocytopenia.
abstract: The optimal management of hematologic malignancy-associated venous thromboembolism (VTE) in patients with moderate-to-severe thrombocytopenia is unclear. This is a retrospective study of 128 adult patients with hematologic malignancies who were diagnosed with VTE. The outcome of patients with significant thrombocytopenia (≤50,000/µL) was compared with those without. Forty-seven patients (36.7%) had a platelet count ≤50,000/µL during a period of time of perceived need for new or continued anticoagulation. The median nadir platelet count in those with significant thrombocytopenia was 10,000/µL (range 2,000-45,000/µL) versus 165,000/µL (50,000-429,000/µL) in those without (P < 0.001). The median duration of significant thrombocytopenia in the first group was 10 days (1-35 days). Therapy during the period of significant thrombocytopenia included prophylactic-dose low-molecular-weight heparin (LMWH) (47%), therapeutic-dose LMWH or heparin (30%), warfarin (2%), inferior vena cava filter (2%), and observation (17%). Patients without thrombocytopenia were managed with the standard of care therapy. At a median follow-up of more than 2 years, the risk of clinically significant bleeding (11% vs 6%, P = 0.22) including major bleeding (6% vs 2%) and clot progression or recurrence (21% vs 22%, P = 1.00) were similar in patients with or without significant thrombocytopenia. In a multivariate analysis, the risk of recurrence/progression (hazard ratio, HR 0.59, 95% CI 0.21-1.66, P = 0.31) and hemorrhage rate (HR 0.29, 95% CI 0.05-1.56, P = 0.15) did not differ based on the presence of significant thrombocytopenia. Within the limits of this retrospective study, cautious use of prophylactic-dose LMWH may be safe in thrombocytopenic patients with hematologic malignancy-associated VTE. Am. J. Hematol. 91:E468-E472, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska.
authors.forename: Nabin
authors.initials: N
authors.lastname: Khanal
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: R Gregory
authors.initials: RG
authors.lastname: Bociek
authors.affiliation: Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Baojiang
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Bierman
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Maness
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Lunning
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Krishna
authors.initials: K
authors.lastname: Gundabolu
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska. vijaya.bhatt@unmc.edu.
authors.forename: Vijaya R
authors.initials: VR
authors.lastname: Bhatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011292:Premedication; D012008:Recurrence; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D054556:Venous Thromboembolism / Q000209:etiology* / Q000473:pathology; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin