PICC-related upper deep venous thrombosis in patients with hematological malignancies. Management of anticoagulant therapy according to the platelet count

• DOI: 10.1007/s11239-020-02040-8
• Publication Date: 2020-01-24T08:02:55Z
• Authors: Maria Cristina Sc...; Salvatore Giacomo...; Alessandra Serrao; Antonella Bruzzese; Francesca Stocchi; Cristina Santoro; Federico Vozella; Roberto Latagliata; Antonio Chistolini
• Keywords: Adult; Male; Catheterization, Central Venous; Catheters; Platelet Count; Anticoagulants; Venous Thromboembolism; Heparin, Low-Molecular-Weight; Middle Aged; 3. Good health; anticoagulant therapy; PICC; thrombocytopenia; thrombosis; 03 medical and health sciences; 0302 clinical medicine; Fondaparinux; Hematologic Neoplasms; Humans; Female; Retrospective Studies

Peripherally inserted central catheters (PICCs) for central venous access are frequently used in patients with hematological malignancies. Their use may be complicated by upper extremity deep venous thrombosis (UEDVT). Additionally, hematological patients are frequently thrombocytopenic and the optimal management of UEDVT in patients with thrombocytopenia is challenging and poorly standardized. We retrospectively analyzed 50 adult patients affected by hematological malignancies who presented a PICC-associated UEDVT. UEDVT treatment was compared in 3 groups: patients with a platelet count ≥ 50 × 109/l (group1) who underwent a therapeutic dose of low molecular weight heparin (LMWH) or fondaparinux 7.5 mg; patients with a platelet count < 50 × 109/l and ≥ 30 × 109/l (group 2) who were treated with a 50% reduced dose of LMWH or fondaparinux 5 mg; patients with platelets < 30 × 109/l (group 3) were observed and treated with anticoagulants when the count was > 30 × 109//l. At the onset of thrombosis, 36 patients were in group 1, 8 in group 2 and 6 in group 3. We observed no hemorrhagic or thrombotic complications related to the anticoagulant therapy; length of treatment was comparable between groups 1 and 2 (51 days group 1 vs 50 days group 2). Reduced doses of LMWH or fondaparinux may represent a safe and effective therapeutic approach in patients with moderate thrombocytopenia (< 50 × 109/l and ≥ 30 × 109/l) and a PICC-associated UEDVT.