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Res Pract Thromb Haemost. 2018 Jun 19;2(4):664-669. doi: 10.1002/rth2.12111. eCollection 2018 Oct.

Management of anticoagulation for cancer-associated thrombosis in patients with thrombocytopenia: A systematic review.

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Division of Hematology Department of Medicine Oregon Health & Science University Portland OR USA.
Division of Hematology Department of Medicine University of British Columbia Vancouver BC Canada.
Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Foundation Cleveland OH USA.
Division of Hemostasis and Thrombosis Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA.
Cottingham Marie Curie Palliative Care Research Centre Cardiff University Cardiff Wales UK.
Clinical Division of Hematology and Hemostaseology Department of Medicine Medical University of Vienna Vienna Austria.
Department of Medicine Ottawa Hospital Research Institute at the University of Ottawa Ottawa ON Canada.



The management of anticoagulation for cancer-associated thrombosis (CAT) in patients with thrombocytopenia is controversial. Whereas some studies suggest that administration of reduced-dose low-molecular-weight heparin (LMWH) or temporary discontinuation for moderate and severe thrombocytopenia may be a safe and effective, others suggest full-dose anticoagulation with transfusion support. We sought to address this important knowledge gap and summarize the literature comparing these two common management strategies.


A systematic review of the literature (PROSPERO CRD42017077127) using MEDLINE (inception to September 2017) was conducted. We included studies that reported recurrent venous thromboembolism (VTE) and major bleeding complications among patients treated with both of the two most common management strategies: therapeutic anticoagulation with platelet transfusion support and dose-modified anticoagulation for periods when the platelet count is <50 × 109/L.


A total of 134 article records were identified on the initial search and 10 articles underwent full text review. Two observational studies met the inclusions criteria. A total of 121 patients with CAT and thrombocytopenia were included. Forty-two of these patients had pulmonary embolism and 87 had deep vein thrombosis (DVT) including 38 upper extremity DVT. Overall, 27% of patients, regardless of their treatment strategy, experienced recurrent VTE. Thirteen percent of anticoagulated patients (15% of all patients) experienced a major bleeding episode. Meta-analysis could not be conducted.


Our findings do not support one management strategy over another to treat CAT patients with thrombocytopenia. However, the data highlights the heightened risk of recurrent VTE in this patient population despite the thrombocytopenia.


hemorrhage; neoplams; thrombocytopenia; venous thromboembolism; venous thrombosis

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