STrategies for Anticoagulation in Patients With thRombocytopenia and Cancer-associated Thrombosis
Cancer-associated Thrombosis, Thrombocytopenia
About this trial
This is an interventional treatment trial for Cancer-associated Thrombosis
Eligibility Criteria
Inclusion Criteria:
- Adult patients (age ≥ 18) with active malignancy (malignancy diagnosed or treated within the previous 6 months, or progressive/relapsed);
- Objectively confirmed VTE within last 30 days for which therapeutic anticoagulation is planned;
- Thrombocytopenia with a platelet count < 50,000/uL from cancer therapy or malignancy itself;
- Able to provide written informed consent
Exclusion Criteria:
- Receipt of anticoagulant for index VTE with platelet count < 50,000/uL for > 72 hours;
- Life expectancy < 3 months (as judged by the treating physicians);
- Creatinine clearance < 30 ml/min;
- Contraindication to LMWH such as a history of heparin induced thrombocytopenia;
- Thrombocytopenia from other causes, such as thrombotic microangiopathy, immune thrombocytopenia, disseminated intravascular coagulation;
- Previously documented history of refractoriness to platelet transfusion secondary to HLA antibodies;
- Refusal of blood products;
- Anticoagulation at any dose is deemed unsafe (i.e. active bleeding or bleeding disorders)
Sites / Locations
- The Ottawa HospitalRecruiting
- Windsor Regional HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Modified dose LMWH without platelet transfusion support
Higher dose LMWH with platelet transfusion support
Patients will be given modified dose LMWH as below based on the first platelet count of the day (daily in admitted patients or at least 2 times a week in outpatients), without empiric platelet transfusion: I. Platelet count 25-50,000/µL: 50% dose LMWH II. Platelet count < 25,000/µL: hold anticoagulation
Patients assigned to higher dose LMWH (see below) will be given transfusion for 14 days when the first platelet count of the day falls below 50,000/uL (daily inpatient or at least 2 times a week in outpatients). Post-transfusion counts will not be routinely obtained unless clinically indicated I. Platelet count 25-50,000/µL: platelet transfusion + 100% dose LMWH II. Platelet count < 25,000/µL: platelet transfusion + 50% dose LMWH After Day 14, patients will be transitioned to modified dose LMWH as the other arm without platelet transfusion. LMWH can include enoxaparin, dalteparin, or tinzaparin, with 100% as: Enoxaparin - 1mg/kg subcutaneously twice daily Dalteparin - 200 IU/kg subcutaneously daily for 1 month then 150 U/kg daily Tinzaparin - 175 units/kg subcutaneously daily