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Anticoagulation and Antiplatelet Guidelines

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Blood and Marrow Transplant Handbook

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Abstract

Patients undergoing hematopoietic cell transplant (HCT) are at risk for both arterial and venous thrombosis, similar to patients with solid organ malignancies, as well as for increased bleeding. Use of anticoagulant and antiplatelet agents in this population can be challenging given unique risk factors for both thrombosis and bleeding including frequent, significant disease- or treatment-related thrombocytopenia, systemic inflammation related to infection, graft-versus-host disease (GvHD) and malignancy itself, and multiple drug–drug interactions. Proper care of these patients requires understanding appropriate indications and contraindications for anticoagulant and antiplatelet therapy, as well as selection of the safest, most effective agent(s).

Providers directing HCT for patients with hematologic malignancies are often faced with one of two scenarios: how to manage anticoagulant and/or antiplatelet therapy for patients already on these drugs, and how to manage patients who develop new indications for these drug classes during the HCT process. Indications for anticoagulation typically fall under three main categories: (1) venous thromboembolic disease (VTE), (2) atrial fibrillation (AF), and (3) mechanical cardiac valves. Indications for antiplatelet therapy typically include (1) primary prevention for cardiovascular events (myocardial infarction and ischemic stroke), (2) secondary prevention of future cardiovascular events, and (3) primary prevention of thromboembolic stroke with prosthetic cardiac valves.

Though data and guidelines for the appropriate management of anticoagulant and antiplatelet therapy in patients specifically with hematologic malignancies undergoing HCT are limited, herein critical concepts are highlighted and available data summarized to guide clinicians performing HCT. A summary of recommendations is found in Table 13.1.

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Notes

  1. 1.

    (Positive for lupus anticoagulant; anticardiolipin IgG or IgM antibodies >40 GPL or MPL or >99th percentile; and anti-beta-2-glycoprotein IgG or IgM antibodies >99th percentile).

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Authors and Affiliations

  1. Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Sven R. Olson & Bethany T. Samuelson Bannow

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  1. Sven R. Olson
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  2. Bethany T. Samuelson Bannow
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Correspondence to Sven R. Olson .

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Editors and Affiliations

  1. Center for Hematologic Malignancies Adult Blood and Marrow Transplant & Cell Therapy Program, Knight Cancer Institute Oregon Health & Science University, Portland, OR, USA

    Richard T. Maziarz

  2. Center for Hematologic Malignancies Adult Blood and Marrow Transplant & Cell Therapy Program, Knight Cancer Institute Oregon Health & Science University, Portland, OR, USA

    Susan Schubach Slater

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Olson, S.R., Samuelson Bannow, B.T. (2021). Anticoagulation and Antiplatelet Guidelines. In: Maziarz, R.T., Slater, S.S. (eds) Blood and Marrow Transplant Handbook. Springer, Cham. https://doi.org/10.1007/978-3-030-53626-8_13

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