EHA Guidelines on Management of Antithrombotic Treatments in Thrombocytopenic Patients With Cancer
EHA · 2022 · Europe
Source and licence
- Authors
- Anna Falanga, Avi Leader, Chiara Ambaglio et al.
- Title
- EHA Guidelines on Management of Antithrombotic Treatments in Thrombocytopenic Patients With Cancer
- Journal
- HemaSphere, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC9281983
Licence statement of the original publication
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
General management of patients with antithrombotic therapy and TP
- We advise the following general approach toward all antithrombotic regimens in cancer patients with TP: • To reassess the indication of the antithrombotic therapy, irrespective of TP. • To assess the ongoing associated thrombotic and bleeding risks by identifying generic and cancer-specific factors (Tables 3 and 4). • To anticipate the duration of grade 3–4 TP. • To formulate a clear antithrombotic therapy management plan, to be reassessed frequently according to the individual treatment plan, kinetics of TP and possible complications or comorbidities. • To consider restarting antithrombotic therapy, once the platelet count is consistently above a threshold deemed suitable for full antithrombotic medication, as indicated in each section.
Aspirin
- Considering that the hemorrhagic risk is relatively small for platelet counts >75 × 109/L (grade 1 TP), even while on APT (Table 6), we advise to maintain low-dose aspirin for TP grade 1. For stable grade 2 TP (50–75 × 109/L), we advise to continue low-dose aspirin in the absence of other ongoing major bleeding risk factors. This is supported by small observational studies showing no major bleeding complications for platelet counts >50 × 109/L (Table 6).20 For patients with grade 3 TP (25–50 × 109/L), we advise to withhold aspirin unless multiple CV risk factors are present or comorbidities predisposing to CV events (Table 3), in the absence of other bleeding risk factors (Table 4).139 In this setting also, the type of cancer and chemotherapy predisposing to a higher thrombotic risk should be considered (Table 3). A small study on patients with hematological cancers, known to have a higher thrombotic risk, and platelet count <50 × 109/L,20 reported a significant benefit from low-dose aspirin on CV mortality at 3 years after an acute event (20% versus 60% of survival without and with aspirin, respectively), but this evidence is too limited to advise for always maintaining aspirin in grade 3 TP.
Abstract
In cancer patients, thrombocytopenia can result from bone marrow infiltration or from anticancer medications and represents an important limitation for the use of antithrombotic treatments, including anticoagulant, antiplatelet, and fibrinolytic agents. These drugs are often required for prevention or treatment of cancer-associated thrombosis or for cardioembolic prevention in atrial fibrillation in an increasingly older cancer population. Data indicate that cancer remains an independent risk factor for thrombosis even in case of thrombocytopenia, since mild-to-moderate thrombocytopenia does not protect against arterial or venous thrombosis. In addition, cancer patients are at increased risk of antithrombotic drug-associated bleeding, further complicated by thrombocytopenia and acquired hemostatic defects. Furthermore, some anticancer treatments are associated with increased thrombotic risk and may generate interactions affecting the effectiveness or safety of antithrombotic drugs. In this complex scenario, the European Hematology Association in collaboration with the European Society of Cardiology has produced this scientific document to provide a clinical practice guideline to help clinicians in the management of patients with cancer and thrombocytopenia. The Guidelines focus on adult patients with active cancer and a clear indication for anticoagulation, single or dual antiplatelet therapy, their combination, or reperfusion therapy, who have concurrent thrombocytopenia because of either malignancy or anticancer medications. The level of evidence and the strength of the recommendations were discussed according to a Delphi procedure and graded according to the Oxford Centre for Evidence-Based Medicine.
Contents of the original publication
The section headings of the original.
- INTRODUCTION
- METHODOLOGY
- Target population
- Recommendation process
- Definitions
- ANTITHROMBOTIC THERAPY
- General management of patients with antithrombotic therapy and TP
- Assessing the risk of TP in patients receiving antithrombotic therapy
- Strategies for increasing platelet count
- ANTICOAGULANT THERAPY
- Therapeutic doses of parenteral and oral anticoagulation
- Prophylactic Dose Anticoagulation
- Perioperative anticoagulation
- ANTIPLATELET THERAPY
- Single antiplatelet therapy
- Dual antiplatelet therapy
- COMBINED APT AND OAC
- APT and full-dose OAC
- Aspirin and very low-dose DOAC
- REPERFUSION THERAPY
- Reperfusion strategies for patients with AIS and TP
- Systemic Thrombolytic Therapy and Complex Reperfusion Strategies for Patients With tp and pe
- CONCLUSIONS
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