LMWH Protocol for Thrombocytopenia Validated in Study

TOP - February 2016, Vol 9, No 1 - Guidelines
Caroline Helwick

Orlando, FL–Guidelines for enoxaparin dose reduction when treating chemotherapy-induced thrombocytopenia (CIT) have been validated by a quality assessment study conducted at Memorial Sloan Kettering Cancer Center (MSKCC) in New York.

"Our quality assessment project supports the safety and efficacy of our guidelines for therapeutic dose modifications of low-molecular-weight heparin (LMWH) in the setting of CIT," said Gerald A. Soff, MD, Chief, Hematology Service, MSKCC, who discussed the study at a press briefing during the 57th American Society of Hematology Annual Meeting & Exposition.

"With appropriate adherence to our guidelines, we saw gratifying safety and efficacy results," Dr Soff said. "I think this will have an impact in reassuring practitioners."

MSKCC Guidelines for LMWH Dosing

Thrombosis is the second leading cause of death in patients with cancer. It is commonly treated with anticoagulation, but this carries an increased risk of bleeding.

In 2011, MSKCC implemented guidelines for LMWH dose modifications in the thrombocytopenia setting: administer full-dose LMWH for a platelet count >50,000 µL; give a half dose for a platelet count 25,000 µL to 50,000 µL; and hold LMWH temporarily when platelet counts are <25,000 µL.

"The current approach to LMWH dosing in the setting of CIT is empirical and based on limited published experience. This approach was never validated prospectively," Dr Soff and colleagues indicated. To evaluate the safety and efficacy of these guidelines, Dr Soff and his team conducted a retrospective analysis of outcomes in patients with cancer who were thrombocytopenic for ≥7 days, and received therapeutic doses of enoxaparin, between 2011 and 2013. Thrombocytopenia was associated with chemotherapy in 79% of the cases.

"We followed patients rigorously, to give us an opportunity to validate the adequacy and adherence to the guidelines," Dr Soff explained.

High Adherence, Excellent Outcomes

They identified 102 patients with a collective 143 episodes of CIT. Enoxaparin doses were modified in 136 (95%) patients, demonstrating high adherence by clinicians to the institution's guidelines, he reported.

"We were gratified to notice that MSKCC doctors were following the guidelines," Dr Soff commented. "But most gratifying was that the outcomes were exactly as one would hope."

The LMWH doses were reduced in 20 (14%) episodes, held in 89 (62%) episodes, managed with a combination of reduction or holding in 27 (19%) episodes, and left 7 (5%) unchanged. In general, the more severe thrombocytopenic episodes were managed with holding LMWH, as opposed to dose reduction, the study authors said.

None of the patients experienced recurrent thrombosis or major bleeds when the anticoagulant management guidelines were followed, Dr Soff added.

The investigators cautioned that their results should not be extrapolated to other anticoagulants.

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Last modified: February 26, 2016