Late last week at the VA, Dr. Nivi Arora (rising PGY3) asked the question “How do I handle prophylactic anticoagulation in my patient with acute myeloid leukemia undergoing induction therapy?”
This is a complicated question, weighing the risk of VTE in patients who are presumed to be hypercoagulable vs the risk of significant hemorrhage as these patients become pancytopenic. However, some studies do exist to assist us with our decision-making.
– The pathogenesis of VTE in acute leukemias is multifactorial and difficult to predict
– Venous thromboembolism occurs in 8-10% of patients with AML during induction chemotherapy with 7+3.
– Increased D-dimer >4.0 mg/L may be predictive of a thrombotic event.
– There is a wide variability in practice patterns with regards to VTE prophylaxis. Most who chose to order VTE prophylaxis used a platelet count of 50k/uL as the cutoff for discontinuing prophylaxis, although this was also variable. The most popular VTE prophylaxis method is SCDs, followed by heparin +/- SCDs
BLOOD, 6 OCTOBER 2016 x VOLUME 128, NUMBER 14
CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA, DECEMBER 2015, COLUME 15, NUMBER 12