Safety of anticoagulation in the treatment of venous thromboembolism in patients with haematological malignancies and thrombocytopenia: Report of 5 cases and literature review

- There are limited studies on the safety of anticoagulation in the treatment of VTE in patients with haematological malignancies and thrombocytopenia.
- Current recommendations regarding the treatment of VTE in this population are expert opinion and not evidence based.
- In our case cohort of 5 patients treated with low molecular weight heparin, major bleeding occurred in 2 patients, and was fatal in one case.
- More studies are required to evaluate the risk factors and safety of anticoagulation in these patients.

Venous thromboembolism (VTE) is relatively common among patients with haematological malignancies. Management is challenging because many of these patients are also thrombocytopenic and at increased risk of bleeding. Current recommendations regarding the treatment of VTE in thrombocytopenic patients with haematological malignancies are limited as there only few studies evaluating the safety and efficacy of anticoagulation in this population of patient. A literature review on the safety of antithrombotic therapy for treatment or prophylaxis of VTE in patients with haematological malignancies was undertaken. This includes a report on 5 patients with haematological malignancies at our institute who received enoxaparin for treatment of VTE while thrombocytopenic. Unlike previous case series which showed that the use of LMWH (low molecular weight heparin) is safe in this group of patients, major bleeding occurred in 2 patients, and was fatal in one case. More studies are required to evaluate the risk factors and safety of anticoagulation in these patients.