24 December 2015 (Thursday) - Anticoagulation

I finally read the weekly BloodMed email . It comes in weekly. Sometimes it has snippets of note; often it doesn’t. Today’s was interesting though. Researchers have investigated the effectiveness of guidelines on anticoagulation treatment among susceptible cancer patients.

Some cancer patients develop chemotherapy-induced thrombocytopenia during treatment, and have an increased risk of bleeding. Treatment for their bleeding risk must be weighed up against the risk of thrombosis.

At present, guidelines recommend using the anticoagulant low-molecular-weight heparin, but the evidence supporting the correct dosage for chemotherapy-induced thrombocytopenia is limited.

So a study was conducted on the safety and efficacy of the current guidelines. They looked back at the outcomes of cancer patients from 2011 to 2013 who had thrombocytopenia for a minimum of a week, and were given a low-molecular-weight heparin.

This included 102 patients, who had a total of 143 episodes of thrombocytopenia. Drug doses were reduced in 20 episodes, withheld in 89 episodes, and treated with a combination of reduction or withheld in 27 episodes.

During 95% of the episodes, medication dose adhered to the institution's guidelines. None of the patients had a relapse of their thrombosis or a major bleed when their treatment was in line with the anticoagulant guidelines.

Dr Soff and his team say: "The data support the safety and efficacy of following the Memorial Sloan Kettering Cancer Center guidelines for therapeutic low-molecular-weight heparin dose modification, balancing the dual risks of recurrent thrombosis and potential bleeding during periods of chemotherapy-induced thrombocytopenia in cancer patients. More research is needed to see if a similar strategy would be appropriate for other oral anticoagulants."

The research was presented on 5 December at the 57th American Society of Hematology (ASH) Annual Meeting held in Orlando, Florida, USA.

Soff, G. et al. Enoxaparin Dose Reduction for Thrombocytopenia in Patients with Cancer: A Quality Assessment Study. Presented at the 57th American Society of Hematology (ASH) Annual Meeting held 5-8 December 2015 in Orlando, Florida, USA.