STrategies for Anticoagulation in Patients With thRombocytopenia and Cancer-associated Thrombosis

Launched by OTTAWA HOSPITAL RESEARCH INSTITUTE · Feb 15, 2022

Keywords

ClinConnect Summary

This clinical trial is studying the best way to treat patients with cancer who have blood clots and low platelet counts. Blood clots are common in cancer patients, and they are usually treated with blood thinners, which help prevent more clots. However, if a patient has a low number of platelets—cells that help stop bleeding—they are at a higher risk of bleeding when using blood thinners. The trial will include 50 adult patients with cancer, diagnosed with a blood clot in the last 14 days and with platelet counts below 50,000. Participants must be able to provide consent and have had recent cancer treatment.

In this pilot study, participants will be randomly assigned to receive either a full dose of blood thinners along with a platelet transfusion or a lower dose of blood thinners without the transfusion. The study will follow patients for 90 days to see which treatment works better. If successful, this research could lead to a larger trial that will help determine the safest and most effective treatment strategies for patients with cancer, low platelets, and blood clots. This is an important step in improving care for these patients.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Adult patients (age ≥ 18) with active malignancy (malignancy diagnosed or treated within the previous 6 months, or progressive/relapsed);
• • 2. Objectively confirmed VTE within last 14 days for which therapeutic anticoagulation is planned;
• • 3. Thrombocytopenia with a platelet count \< 50,000/uL from cancer therapy or malignancy itself;
• • 4. Able to provide written informed consent
• Exclusion Criteria:
• • 1. Receipt of anticoagulant for index VTE with platelet count \< 50,000/uL for \> 72 hours;
• • 2. Superficial vein thrombosis only;
• • 3. Life expectancy \< 1 month (as judged by the treating physicians);
• • 4. Creatinine clearance \< 30 ml/min;
• • 5. Contraindication to LMWH such as a history of heparin induced thrombocytopenia;
• • 6. Thrombocytopenia from other causes, such as thrombotic microangiopathy, immune thrombocytopenia, disseminated intravascular coagulation;
• • 7. Previously documented history of refractoriness to platelet transfusion secondary to HLA antibodies;
• • 8. Refusal of blood products;
• • 9. Anticoagulation at any dose is deemed unsafe (i.e. active bleeding or bleeding disorders)