Impact of thrombocytopenia on bleeding and thrombotic outcomes in adults with cancer-associated splanchnic vein thrombosis Journal Article
| Authors: | Andersen, M. Jr; Fernandez Turizo, M. J.; Dodge, L. E.; Hsu, C.; Barnum, K.; Berry, J.; Zwicker, J. I.; Patell, R. |
| Article Title: | Impact of thrombocytopenia on bleeding and thrombotic outcomes in adults with cancer-associated splanchnic vein thrombosis |
| Abstract: | Malignancy is a risk factor for splanchnic vein thrombosis (SpVT). Data on the natural history of cancer-associated SpVT are limited. This was a single-center, retrospective cohort study of 581 adult patients with cancer and SpVT. We aimed to characterize the impact of thrombocytopenia on major bleeding and progression or recurrence of SpVT within 1 year of an initial cancer-associated SpVT diagnosis. Baseline thrombocytopenia (platelet <100 × 103/μL within 15 days of SpVT diagnosis) was present in 39.5% of patients. A total of 39.2% of patients received therapeutic anticoagulation within 2 weeks of an SpVT diagnosis. The cumulative 1-year incidence of major bleeding was 10.7% (95% confidence interval [CI], 8.2-13.2) and 16.2% (95% CI, 13.2-19.2) for SpVT recurrence/progression. In the multivariable regression analysis, therapeutic anticoagulation was associated with increased major bleeding (adjusted risk ratio [aRR], 1.74; 95% CI, 1.08-2.81) and decreased progression/ recurrence of SpVT (aRR, 0.55; 95% CI, 0.35-0.86). Baseline thrombocytopenia was not independently associated with either major bleeding (aRR, 0.76; 95% CI, 0.43-1.34) or progression/recurrence of SpVT (aRR, 1.14; 95% CI, 0.73-1.78). A secondary analysis using inverse probability of treatment weighting with propensity scores for baseline thrombocytopenia corroborated that patients with thrombocytopenia did not have an increased bleeding risk (adjusted hazard ratio [aHR], 0.81; 95% CI, 0.48-1.39). The multivariable analysis in which platelets were treated as a time varying covariate also did not reveal an association with major bleeding (aHR, 0.89; 95% CI, 0.55-1.45). Bleeding and thrombosis progression were frequent in patients with cancer-associated SpVT. Anticoagulation was associated with increased major bleeding and decreased thrombotic progression; thrombocytopenia did not impact the outcomes. © 2024 by The American Society of Hematology. |
| Keywords: | adult; controlled study; treatment outcome; middle aged; major clinical study; clinical feature; mortality; liver cirrhosis; systemic therapy; cancer staging; recurrence risk; cancer diagnosis; thrombocytopenia; cohort analysis; creatinine; hemoglobin; anticoagulant therapy; deep vein thrombosis; retrospective study; risk factor; lung embolism; prothrombin time; thrombosis; comorbidity; warfarin; heparin; abdominal surgery; disease exacerbation; fondaparinux; platelet count; low molecular weight heparin; partial thromboplastin time; venous thromboembolism; cumulative incidence; tumor thrombus; propensity score; mechanical thrombectomy; human; male; female; article; splanchnic vein thrombosis; dual antiplatelet therapy; major bleeding |
| Journal Title: | Blood Advances |
| Volume: | 8 |
| Issue: | 24 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2024-12-24 |
| Start Page: | 6151 |
| End Page: | 6160 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2024014249 |
| PUBMED: | 39418642 |
| PROVIDER: | scopus |
| PMCID: | PMC11696637 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus |
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