Prevention of venous thromboembolism in medical patients with thrombocytopenia or with platelet dysfunction: a review of the literature.
Summary of "Prevention of venous thromboembolism in medical patients with thrombocytopenia or with platelet dysfunction: a review of the literature."
Current guidelines for venous thromboembolism (VTE) primary prophylaxis are based on randomized clinical trials that exclude subjects at a potentially high bleeding risk. Thus no specific recommendation/algorithm for pharmacological prophylaxis in patients with thrombocytopenia and/or platelet dysfunction is available. Because at least 25% of subjects admitted to medical departments exhibit these conditions, information on this subject is provided here to optimize their VTE prophylaxis. Low platelet number/function and clotting abnormalities are common in patients with liver cirrhosis. However, these patients have a high incidence of portal and idiopathic venous thromboses, implying that cirrhotic coagulopathy does not protect against thrombosis. At variance with severe thrombocytopenia (< 50,000/μL), mild/moderate thrombocytopenia (> 50,000/μL) should not interfere with VTE prevention decisions. In severe thrombocytopenia, prophylaxis should be considered on an individual basis, however. In patients with antiphospholipid antibodies and thrombocytopenia, a thrombotic tendency is usually associated rather than a bleeding risk. VTE prophylaxis in high-risk conditions is thus suggested in these patients. Except in cases with contraindications to anticoagulation, antithrombotic prophylaxis should be always considered in hospitalized cancer patients with thrombocytopenia, especially in those with hematologic malignancies and multiple VTE risk factors. Aspirin treatment is not as effective as heparins in lowering the risk of VTE. Studies in stroke suggest that thromboprophylaxis with heparins is safe in patients with ischemic stroke undergoing aspirin treatment. The need for VTE prophylaxis in patients on chronic treatment with aspirin and/or clopidogrel should be evaluated after assessing the individual risk-benefit ratio.
Affiliation
Regional Reference Centre for Coagulation Disorders, Department of Clinical and Experimental Medicine, "Federico II" University of Naples.
Journal Details
This article was published in the following journal.
Name: Seminars in thrombosis and hemostasis
ISSN: 1098-9064
Pages: 267-74
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21455860
- DOI: http://dx.doi.org/10.1055/s-0031-1273090
Medical and Biotech [MESH] Definitions
Venous Insufficiency
Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Venous Thromboembolism
Obstruction of a vein or VEINS (embolism) by a blood clot (THROMBUS) in the blood stream.
Preventive Medicine
A medical specialty primarily concerned with prevention of disease (PRIMARY PREVENTION) and the promotion and preservation of health in the individual.
Intermittent Pneumatic Compression Devices
Instruments that generate intermittent forces, uniformed or graduated, to facilitate the emptying of VEINS. These devices are used to reduce limb EDEMA and prevent venous THROMBOEMBOLISM, such as deep vein thrombosis in the legs.
Jacobsen Distal 11q Deletion Syndrome
A clinically recognized malformation condition caused by a distal 11q deletion. The features of the syndrome are growth retardation, psychomotor retardation, trigonocephaly, divergent intermittent strabismus, epicanthus, telecanthus, broad nasal bridge, short nose with anteverted nostrils, carp-shaped upper lip, retrognathia, low-set dysmorphic ears, bilateral camptodactyly, and hammertoes. Most patients have a THROMBOCYTOPENIA and platelet dysfunction known also as Paris-Trousseau type thrombocytopenia.
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Aspirin for preventing venous thromboembolism.
To the Editor: In their report on the Aspirin to Prevent Recurrent Venous Thromboembolism (ASPIRE) trial, Brighton et al. (Nov. 22 issue)(1) describe a nonsignificant decrease in the rate of recurrent...
Aspirin for preventing venous thromboembolism.
To the Editor: In their report on the Aspirin to Prevent Recurrent Venous Thromboembolism (ASPIRE) trial, Brighton et al. (Nov. 22 issue)(1) describe a nonsignificant decrease in the rate of recurrent...
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