ABSTRACT
Heparin-induced thrombocytopenia (HIT) is a highly thrombogenic condition. Cancer patients are already at high risk of thrombosis. The treatment and outcomes of HIT in cancer patients are not well established. We retrospectively identified patients with active cancer who were diagnosed with HIT at our institution. Only patients with a positive HIT assay and intermediate to high 4Ts score were included. We assessed patients for baseline characteristics, HIT characteristics, non-heparin agent usage, and outcomes (recurrent thrombosis, bleeding, and death) up to 180 days after diagnosis of HIT. Between November 1, 2006 and December 31, 2016, 39 patients with active cancer received a diagnosis of HIT. Of these, 35.9% had thrombotic complications at diagnosis. Gastrointestinal cancer was the most common solid organ malignancy while myeloproliferative neoplasm (MPN) was the most common hematological malignancy. Fondaparinux was the most often used parenteral agent at any point of follow-up (87.2%), followed by argatroban (41.0%). Less than half the patients transitioned to an oral agent. The recurrent thrombosis rate was 17.9%, the bleeding rate was 20.5%, the major bleeding rate was 10.3%, and the mortality rate was 15.4% in the entire cohort. HIT in cancer patients is associated with poor outcomes.
Subject(s)
Arginine/analogs & derivatives , Fondaparinux , Gastrointestinal Neoplasms/complications , Hematologic Neoplasms/complications , Heparin , Pipecolic Acids , Sulfonamides , Thrombocytopenia , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Arginine/administration & dosage , Arginine/adverse effects , Canada/epidemiology , Female , Fondaparinux/administration & dosage , Fondaparinux/adverse effects , Gastrointestinal Neoplasms/mortality , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/therapy , Hematologic Neoplasms/mortality , Hematologic Neoplasms/pathology , Hematologic Neoplasms/therapy , Hemorrhage/chemically induced , Heparin/administration & dosage , Heparin/adverse effects , Humans , Male , Patient Acuity , Pipecolic Acids/administration & dosage , Pipecolic Acids/adverse effects , Platelet Count/methods , Platelet Count/statistics & numerical data , Retrospective Studies , Risk Adjustment/methods , Sulfonamides/administration & dosage , Sulfonamides/adverse effects , Thrombocytopenia/chemically induced , Thrombocytopenia/diagnosis , Thrombocytopenia/prevention & controlABSTRACT
Venous thromboembolism (VTE) occurs frequently in patients with cancer. It can be difficult to manage, sometimes delay cancer therapy and predicts for a worse prognosis. Hence, effective methods to prevent and treat VTE can reduce morbidity and mortality. Prophylaxis with anticoagulants is recommended for patients hospitalized for surgery or medical conditions, but is not routinely administered in the ambulatory setting. Traditional anticoagulation with a heparin followed by vitamin K antagonist therapy for cancer patients with acute VTE is associated with a high frequency of treatment failure and bleeding complications. Low molecular weight heparins (LMWHs) have simplified and improved the management of VTE, and recent studies suggest these agents may improve survival in patients with limited or early stage disease. This brief review will provide an update on the primary prevention and treatment of VTE and discuss the evidence for the survival advantage associated with LMWH use in patients with malignancy.
