Guidance for anticoagulation management in the setting of thrombocytopenia in cancer patients

Dr Soff talks to ecancertv at ASH 2015 about the results of a study that prospectively assessed the efficacy and safety of an algorithm for reducing the dose of low molecular weight heparin (LMWH) in patients with cancer-associated thrombosis who develop chemotherapy-induced thrombocytopenia (CIT).
CIT is a common problem in anticoagulated cancer patients and the current recommendation on how to amend LMWH is based on expert opinion rather published evidence, Dr Soff explains. The present study therefore aimed to address this knowledge gap and considered all 15,000 cancer patients treated with LMWH (enoxaparin) at Memorial Sloan Kettering Cancer Center over a 3-year period.
There were 143 patients who developed CIT and results showed that holding anticoagulant therapy was an appropriate approach if platelet levels fell below 25,000/mcL. Halving the dose of LMWH was appropriate if the platelet count was 25,000/mcL to 50,000/mcL and continuing LMWH at full dose if the platelet count was more than 50,000/mcL.