Effects of antiplatelet and anticoagulant medications on the vasoocclusive and thrombotic complications of sickle cell disease: A review of the literature.

PURPOSE: The effects of antiplatelet and anticoagulant medications on the vasoocclusive and thrombotic complications of sickle cell disease are reviewed.

SUMMARY: Sickle cell disease is a chronic, inherited disorder characterized by chronic hemolytic anemia and vasoocclusive crisis. Evidence suggests that circulating platelets in patients with sickle cell disease are chronically activated. It is not known whether this is a result of the overall hypercoagulable state or related to the process of vasoocclusion. The extent to which hypercoagulability contributes to vasoocclusion is unknown but makes the use of antiplatelet and anticoagulant medications seem intuitive for preventing and treating vasoocclusive and thrombotic complications of sickle cell disease. Multiple studies have been conducted to determine the effects of antiplatelet and anticoagulant medication on the vasoocclusive and thrombotic complications of sickle cell disease, but many studies were poorly designed, and all were small or uncontrolled. Based on limited data and poorly designed trials, no compelling data exist at this time to recommend aspirin, dipyridamole, ticlopidine, heparin, or vitamin K antagonists for the prevention of vasoocclusive and thrombotic complications in sickle cell disease. For this reason, sickle cell disease should not be used as an independent indication for treatment with an antiplatelet or anticoagulant medication. Clinicians should treat patients with other compelling indications for these therapies according to the American College of Chest Physicians evidence-based clinical practice guidelines (8th edition).

CONCLUSION

Based on the existing data, sickle cell disease should not be used as an independent indication for treatment with an antiplatelet or anticoagulant medication.