Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: an expert consensus.
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Napolitano Mariasanta, Saccullo Giorgia, Marietta Marco, Carpenedo Monica, Castaman Giancarlo, Cerchiara Elisabetta, Chistolini Antonio, Contino Laura, De Stefano Valerio, Falanga Anna, Federici Augusto B, Rossi Elena, Santoro Rita, Siragusa Sergio, Gruppo Italiano Malattie EMatologiche dell’Adulto (GIMEMA) Working Party on Thrombosis and Hemostasis, Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) Working Party on Thrombosis and Haemostasis (see Appendix 1), De Stefano Valerio, Falanga Anna, Tosetto Alberto, Avvisati Giuseppe, Carpenedo Monica, Federici Augusto B, Marietta Marco, Napolitano Mariasanta, Rossi Elena, Santoro Cristina, Castaman Giancarlo, Cerchiara Elisabetta, Chistolini Antonio, Contino Laura, Mazzucconi Maria Gabriella, Nichele Ilaria, Russo Laura, Santi Roberto, Santoro Rita Carlotta, Siragusa Sergio, Tagariello Giuseppe
Аннотация
METHODS: Given this, an expert panel endorsed by the Gruppo Italiano Malattie Ematologiche dell'Adulto Working Party on Thrombosis and Haemostasis was set up to produce a formal consensus, according to the RAND method, in order to issue clinical recommendations about the platelet (PLT) cut-off for safe administration of low molecular weight heparin (LMWH) in thrombocytopenic (PLT <100×109/L) adult patients with haematologic malignancies affected by acute (<1 month) or non-acute VTE.
RESULTS: In acute VTE, the panel suggests safe anticoagulation with LMWH at therapeutic doses for PLT between ≥50<100×109/L and at 50% dose reduction for PLT ≥30<50×109/L. In acute VTE for PLT <30×109/L, the following interventions are recommended: positioning of an inferior vena cava (IVC) filter with prophylactic LMWH administration and platelet transfusion. In non-acute VTE, anticoagulation with LMWH at therapeutic doses for PLT between ≥50<100×109/L or over and at 50% dose reduction for PLT ≥30<50×109/L is considered appropriate. The discontinuation of full or reduced therapeutic dose of LMWH is recommended for PLT <30×109/L, both in acute and non-acute VTE.
DISCUSSION: We suggest using dose-adjusted LMWH according to PLT to optimise anticoagulant treatment in patients at high bleeding risk.