Challenges and advances in managing thrombocytopenic cancer patients

Avi Leader, Liron Hofstetter, Galia Spectre

Research output: Contribution to journalReview articlepeer-review

Abstract

Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been stud-ied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

Original languageEnglish
Article number1169
Pages (from-to)1-21
Number of pages21
JournalJournal of Clinical Medicine
Volume10
Issue number6
DOIs
StatePublished - 2 Mar 2021

Keywords

  • Anticoagulation
  • Antifibrinolytic
  • Antiplatelet
  • Cancer
  • Thrombocytopenia
  • Thrombopoietin receptor agonist
  • Tranexamic acid

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