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

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Abstract

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.

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Authors and Affiliations

  1. Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161, Rome, Italy

    Maria Cristina Scamuffa, Salvatore Giacomo Morano, Alessandra Serrao, Antonella Bruzzese, Francesca Stocchi, Cristina Santoro, Federico Vozella, Roberto Latagliata & Antonio Chistolini

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  1. Maria Cristina Scamuffa
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  2. Salvatore Giacomo Morano
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  3. Alessandra Serrao
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  4. Antonella Bruzzese
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  5. Francesca Stocchi
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  6. Cristina Santoro
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  7. Federico Vozella
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  8. Roberto Latagliata
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  9. Antonio Chistolini
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Correspondence to Antonio Chistolini.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consents were retrospectively obtained from patients or familiars for being included in the study.

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Scamuffa, M.C., Morano, S.G., Serrao, A. et al. PICC-related upper deep venous thrombosis in patients with hematological malignancies. Management of anticoagulant therapy according to the platelet count. J Thromb Thrombolysis 49, 426–430 (2020). https://doi.org/10.1007/s11239-020-02040-8

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  • DOI: https://doi.org/10.1007/s11239-020-02040-8

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