Cancer patients commonly develop thrombosis and are often prescribed therapeutic anticoagulants while on chemotherapy.

Thrombocytopenia, a condition characterised by a deficiency of platelets in the blood, is a common adverse event associated with chemotherapy.

Patients with chemotherapy-induced thrombocytopenia (CIT) have an increased risk of bleeding.

Managing anticoagulation in cancer patients who have CIT is challenging because clinicians must find a balance between the risks of both bleeding and recurrent thrombosis.

The current standard of care for preventing blood clots in a cancer setting includes treatment with low-molecular-weight heparin (LMWH), a type of anticoagulant.

However, there is limited evidence to support proper dosing to treat these episodes in the setting of CIT.

In 2010, Memorial Sloan Kettering Cancer Center (MSK) implemented guidelines for LMWH dose modifications in the setting of thrombocytopenia.

In order to evaluate the safety and efficacy of these guidelines, researchers conducted a retrospective analysis to evaluate the outcomes of cancer patients who were thrombocytopenic for at least seven days and received a therapeutic dose of LMWH from 2011 to 2013.

Investigators identified 102 patients with a collective 143 episodes of thrombocytopenia.

LMWH dose was modified in 136 of the 144 episodes (95%), which showed adherence to the institutional guidelines.

LMWH doses were reduced in 20 episodes, withheld in 89 episodes, and managed with a combination of reduction or withheld in 27 episodes.

In general, the more severe thrombocytopenic episodes were managed with holding LMWH as opposed to dose reduction.

None of the patients experienced recurrent thrombosis or major bleeds when the anticoagulant management guidelines were followed.

The data support the safety and efficacy of following the MSK guidelines for therapeutic LMWH dose modification, balancing the dual risks of recurrent thrombosis and potential bleeding during periods of CIT in cancer patients.

More research is needed to see if a similar strategy would be appropriate for other oral anticoagulants.

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Source: ASH