Anticoagulation in cancer-associated thromboembolism with thrombocytopenia: a prospective, multicenter cohort study

被引：36

作者：

Carney, Brian J. ^{[1
,2
]}

Wang, Tzu-Fei ^{[3
,4
]}

Ren, Siyang ^{[5
]}

George, Gemlyn ^{[6
]}

Al Homssi, Amer ^{[7
]}

Gaddh, Manila ^{[8
]}

Connolly, Gregory C. ^{[9
]}

Shah, Vinay, I ^{[10
]}

Bogue, Thomas ^{[1
,2
]}

Bartosic, Abigail ^{[11
]}

Neuberg, Donna ^{[5
]}

Kreuziger, Lisa Baumann ^{[12
]}

Zwicker, Jeffrey, I ^{[1
,2
]}

机构：

[1] Beth Israel Deaconess Med Ctr, Div Hematol & Hematol Malignancies, 330 Brookline Ave, Boston, MA 02215 USA

[2] Harvard Med Sch, Boston, MA 02115 USA

[3] Univ Ottawa, Dept Med, Ottawa Hosp, Ottawa, ON, Canada

[4] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[5] Dana Farber Canc Inst, Dept Data Sci, Boston, MA 02115 USA

[6] Univ Colorado, Div Hematol, Aurora, CO USA

[7] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[8] Emory Univ, Sch Med, Dept Hematol & Med Oncol, Atlanta, GA USA

[9] Rochester Reg Hlth, Dept Hematol & Med Oncol, Lipson Canc Inst, Rochester, NY USA

[10] Henry Ford Hlth Syst, Detroit, MI USA

[11] Ohio State Univ, Dept Internal Med, Wexner Med Ctr, Div Hematol, Columbus, OH 43210 USA

[12] Versiti Blood Res Inst, Milwaukee, WI USA

来源：

BLOOD ADVANCES | 2021年 / 5卷 / 24期

关键词：

VENOUS-THROMBOEMBOLISM; STRATEGIES; GUIDELINES; THROMBOSIS; VTE;

D O I：

10.1182/bloodadvances.2021005966

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Venous thromboembolism (VTE) with concurrent thrombocytopenia is frequently encountered in patients with cancer. Therapeutic anticoagulation in the setting of thrombocytopenia is associated with a high risk of hemorrhage. Retrospective analyses suggest the utility of modified-dose anticoagulation in this population. To assess the incidence of hemorrhage or thrombosis according to anticoagulation strategy, we performed a prospective, multicenter, observational study. Patients with active malignancy, acute VTE, and concurrent thrombocytopenia (platelet count <100 000/mu L) were enrolled. The cumulative incidences of hemorrhage or recurrent VTE were determined considering death as a competing risk. Primary outcomes were centrally adjudicated and comparisons made according to initial treatment with full-dose or modified-dose anticoagulation. A total of 121 patients were enrolled at 6 hospitals. Seventy-five patients were initially treated with full-dose anticoagulation (62%) and 33 (27%) with modified-dose anticoagulation; 13 (11%) patients received no anticoagulation. Most patients who received modified-dose anticoagulation had a hematologic malignancy (31 of 33 [94%]) and an acute deep vein thrombosis (28 of 33 [85%]). In patients who initially received full-dose anticoagulation, the cumulative incidence of major hemorrhage at 60 days was 12.8% (95% confidence interval [CI], 4.9-20.8) and 6.6% (95% CI, 2.4-15.7) in those who received modified-dose anticoagulation (FineGray hazard ratio, 2.18; 95% CI, 1.21-3.93). The cumulative incidence of recurrent VTE at 60 days in patients who initially received full-dose anticoagulation was 5.6% (95% CI, 0.2-11) and 0% in patients who received modified-dose anticoagulation. In conclusion, modified-dose anticoagulation appears to be a safe alternative to therapeutic anticoagulation in patients with cancer who develop deep vein thrombosis in the setting of thrombocytopenia.

引用

页码：5546 / 5553

页数：8

共 24 条

[1] Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer [J].