title: Analysis of anticoagulation strategies for venous thromboembolism during severe thrombocytopenia in patients with hematologic malignancies: a retrospective cohort.
abstract: The safety and efficacy of anticoagulation for venous thromboembolism (VTE) at times of severe thrombocytopenia is unclear. In this retrospective study, we evaluated patients with hematologic malignancy and either (1) acute or chronic VTE on anticoagulation before platelet count dropped below 50 × 109/L or (2) acute VTE occurring while platelets were <50 × 109/L. In 78 eligible patients, the primary outcomes of time to recurrent VTE or clinically significant bleeding within 100 d were compared by management strategy. Bleeding occurred in 27% of patients receiving anticoagulation versus 3% when anticoagulation was held (IRR 10.1, 95% CI 1.5-432.6). Recurrent VTE occurred in 2% of patients receiving anticoagulation versus 15% when anticoagulation was held (IRR 0.17, 95% CI 0.0-1.51). Most bleeding occurred before day 31(11/13), but recurrent VTE mostly occurred after day 40 (5/6). Our findings suggest that temporarily withholding anticoagulation for VTE during severe thrombocytopenia in patients with hematologic malignancies might reduce adverse outcomes.
authors.affiliation: a Department of Medicine, Division of Hematology/Oncology , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Damon E
authors.initials: DE
authors.lastname: Houghton
authors.affiliation: a Department of Medicine, Division of Hematology/Oncology , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Key
authors.affiliation: b Departments of Medicine and Pathology , University of Vermont , Burlington , VT , USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Zakai
authors.affiliation: c University of North Carolina, The North Carolina Translational and Clinical Sciences (NC TraCS) Institute , Chapel Hill , NC , USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Laux
authors.affiliation: a Department of Medicine, Division of Hematology/Oncology , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.affiliation: a Department of Medicine, Division of Hematology/Oncology , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Moll
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006470:Hemorrhage / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications* / Q000473:pathology; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; hematologic malignancies; hemorrhage; thrombocytopenia; venous thromboembolism