Safety of anticoagulation in thrombocytopenic patients with hematologic malignancies: A case series

The incidence of venous thromboembolism is greater among cancer patients than the general patient population, with recurrence rates also much higher in patients with cancer diagnoses. Patients with hematologic malignancies often experience prolonged periods of thrombocytopenia throughout their disease course, making therapeutic anticoagulation a challenge. We describe 13 cases of patients with hematologic malignancies that were therapeutically anticoagulated with either low-molecular-weight heparin or unfractionated heparin during periods of severe thrombocytopenia (platelet counts < 50 × 10⁹/µL). Patients were included if they had a diagnosis code for a hematologic malignancy and venous thromboembolism between 1 January 2010 and 31 December 2012. The diagnosis of venous thromboembolism included both deep vein thrombosis and pulmonary embolism. There was one bleeding event, World Health Organization grade 2, that was documented in a patient receiving enoxaparin dosed twice daily, resulting in an overall bleeding rate of 7.7% in this case series. All 13 patients were administered platelet transfusions during the periods of severe thrombocytopenia. While each patient case must have the risks and benefits weighed individually, we observed that anticoagulation for the treatment of venous thromboembolism during periods of thrombocytopenia may be considered in patients with hematologic malignancies.