your limit has been reached. plz Donate us to allow your ip full access, Email: sshnevis@outlook.com
Uptodate Reference Title
Anticoagulation for individuals with cancer and thrombocytopenia who develop an acute venous thromboembolism
Anticoagulation for individuals with cancer and thrombocytopenia who develop an acute venous thromboembolism
This algorithm should not be used for individuals with brain tumors, for whom management is discussed separately in UpToDate. Refer to UpToDate for additional information on our approach, which is mostly based on expert opinion, as well as for management of other patient populations. All patients should have ongoing platelet count monitoring with adjustment of the approach if there is significant worsening or improvement.
This algorithm does not supersede the judgment of the treating clinician, who may be best able to judge the risks and benefits of anticoagulation for the individual patient and to incorporate information about the patient's underlying condition, risk of bleeding, risk of thrombotic complications, and values and preferences.
LMWH is the most commonly used anticoagulant in patients with cancer. Adjustments may be indicated for renal or hepatic insufficiency, drug interactions, and extremes of body weight. Unfractionated heparin may be used in individuals with renal failure. The duration of therapy depends on the underlying cause of VTE and whether it was provoked or unprovoked.
VTE: venous thromboembolism; HCT: hematopoietic stem cell transplant; LMWH: low molecular weight heparin; IVC: inferior vena cava; DVT: deep vein thrombosis; PE: pulmonary embolism; ECOG PS: Eastern Cooperative Oncology Group performance status. * Examples of risk factors for bleeding and VTE progression are included in the table above. These lists do not substitute for the judgment of the treating clinician in estimating the risks for a specific patient. ¶ Eg, use enoxaparin 0.5 mg/kg twice daily rather than 1 mg/kg twice daily, assuming normal renal function. LMWH is used in most cases; however, similar principles apply if a different anticoagulant is being used. Δ If anticoagulation is not used, it may be appropriate to perform serial ultrasounds to document the absence of DVT extension, and if there is DVT extension, it may be appropriate to use more aggressive therapy (eg, anticoagulation with platelet support). Decisions about the use of an IVC filter depend on specific patient characteristics and preferences. ◊ Platelet transfusions to maintain the platelet count >50,000/microL are typically used. If this is not feasible, dose-adjusted anticoagulation as described for individuals at low risk for VTE progression or recurrence may be used.
