OC 71.4 - Management Patterns of Antithrombotics and Outcomes in Patients with Hematological Malignancy and Thrombocytopenia: a Prospective Registry (MATTER study)

Wednesday, June 28, 2023

11:00 – 11:15 ET

Room: 710A

Session Available As: On-Demand

Presenting Author(s)

Avi Leader, MD (he/him/his)

Hematologist
Institute of Hematology, Rabin Medical Center, Petah Tikva
Petah Tikva, HaMerkaz, Israel

Co-Author(s)

Galia Spectre, MD PhD

Head of Thrombosis and Haemosasis Unit, Department of Hematology
Institute of Hematology, Rabin Medical Center, Petah Tikva
Petah Tikva, HaMerkaz, Israel
AC

Antonio Chistolini

Director
Dipartimento di Medicina Traslazionale e di Precisione Sapienza Università di Roma
Roma, Lazio, Italy
EB

Erik A.M. Beckers

Head of Haematology
Department of Hematology, Maastricht University Medical Center + and Maastricht University, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
Tessa Elling, MD

PhD student
Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Groningen, Groningen, Netherlands
EB

Eloise Beggiato

Hematologist
Department of Oncology, Divison of Hematology AOU Città della Salute e della Scienza di Torino, Turin, Italy
Turin, Piemonte, Italy
EH

Eva N. Hamulyák

Resident Internal Medicine
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
RR

Ron Ram

Director
BMT Unit, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Tel Aviv, Tel Aviv, Israel
EC

Elisa Cerqui

Hematologist
Department of Hematology, ASST Spedali Civili, Brescia, Italy
Brescia, Lombardia, Italy
Bethany Samuelson Bannow, MD, MCR (she/her/hers)

Assistant Professor of Medicine
Oregon Health & Science University, Portland, Oregon, USA
Portland, Oregon, United States
SS

Sergio Siragusa

Professor of Hematology
Haematology Unit, Thrombosis and Haemostasis Reference Regional Center, University of Palermo, Palermo, Italy
Palermo, Sicilia, Italy
AC

Andrea Carrer

Hematologist
Hematology Unit, IRCCS San Gerardo dei Tintori, Monza, Italy
Monza, Lombardia, Italy
OA

Orly Avnery

Hematologist
Hematology Institute, Meir Medical Center, Kfar Saba, Israel
Kfar Saba, HaMerkaz, Israel
MD

Maria Ilaria Del Principe

Associate Professor
Department of Biomedicine and Prevention, Tor Vergata University of Rome, Italy
Rome, Lazio, Italy
CG

Cinzia Giaccherini

Researcher
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
LR

Laura Russo

Researcher
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
FS

Francesca Schieppati

Hematologist
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
At

Arina J. ten Cate-Hoek

Associate Professor, MD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
Hugo ten Cate, MD, PhD, FAHA (he/him/his)

Professor, MD, PhD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
Anna Falanga, MD (she/her/hers)

Professor of Hematology
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy

Background: Patients with hematological malignancy, thrombocytopenia and antithrombotic therapy are not uncommon. Clinical practice varies widely since evidence on efficacy and safety of management strategies is limited.

Aims: To evaluate management of hematological malignancy patients receiving antithrombotic therapy who develop thrombocytopenia < 50x10^9/L and to assess thrombotic/bleeding outcomes.

Methods: A prospective multinational observational cohort study in adults with hematological malignancy and concurrent thrombocytopenia ( < 50x10^9/L) receiving therapeutic anticoagulation or antiplatelet therapy for any duration. Study index defined as the first day all inclusion criteria coexisted concurrently. Management strategies were documented and the 30-day cumulative incidence of venous thromboembolism (VTE), arterial thrombosis, and bleeding was calculated.

Results: 271 patients were included; 191 receiving anticoagulation and 80 on antiplatelets only (Table 1).

Anticoagulation was held at index in 26.7% (51/191), continued at full-dose in 35.1% (67/191) and dose-reduced in 38.2% (73/191). Median platelet threshold [interquartile range] for transfusing platelets was 10x10^9/L [10-20] prior index. The platelet transfusion threshold was changed at index in 3.9%, 56.7% and 19.2% of patients holding anticoagulation, continuing-full and dose-reducing, respectively. In these patients, the median post-change platelet transfusion threshold was 30x10^9/L [30-30] with full-dose and 27.5x10^9/L [20-30] with reduced-dose anticoagulation. Management was similar in anticoagulation subgroups (Table 2). Thrombotic events occurred across all management groups in VTE patients, but not in atrial fibrillation patients (Table 2). Bleeding occurred across all groups and indications.

Antiplatelet therapy was held in 42% of patients and continued in 58%. Platelet transfusion thresholds were changed in 5.9% and 34.8%, respectively, but changes in thresholds (Tables 1,2) were subtle. Arterial thrombosis was infrequent in the antiplatelet group, and no major bleeding occurred.

Conclusion(s): Antithrombotic therapy management was variable and similar across antithrombotic indications and types. Platelet transfusion thresholds were more frequently increased in patients continuing antithrombotic therapy and highest with anticoagulants. Thrombosis and bleeding profiles differed across indications.

Learning Objectives:

Describe the incidence of bleeding and thrombosis in patients with hematological malignancy, thrombocytopenia and an indication for antithrombotic therapy
List the different approaches to managing antithrombotic therapy in patients with hematological malignancy, thrombocytopenia and an indication for antithrombotic therapy
Describe the incidence of bleeding and thrombosis associated with each antithrombotic management strategy among patients with hematological malignancy and thrombocytopenia