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 »  Abstract
 »  Introduction
 »  Materials and Me...
 »  Results
 »  Conclusions
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ORIGINAL ARTICLE
Year : 2011  |  Volume : 17  |  Issue : 1  |  Page : 54-56

Anticoagulant and anti-thrombotic treatments in the management of hematological malignancies in a home care program


1 Hematology Unit, S. Eugenio Hospital, Rome, Italy
2 Hematology, Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome, Italy
3 Laboratory Medicine, "Sandro Pertini" Hospital, Rome, Italy

Date of Web Publication29-Mar-2011

Correspondence Address:
Pasquale Niscola
Hematology Unit, S. Eugenio Hospital, Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.78450

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 » Abstract 

Aim: Anticoagulants (AC) and anti-platelet (AP) agents are widely administered to patients with hematological malignancies (HM). However, HM patients may be at high risk of bleeding and hemorrhagic complications, because of different form of coagulopathies and several degrees of thrombocytopenia.
Materials and Methods: A prospective evaluation of the use of anticoagulant and anti-thrombotic agents as well as of bleeding and thrombotic complications in a consecutive cohort of patients, which were followed during the first semester of 2010 by our home care service, was performed. In this regard, three pharmacological class of agents, such as oral anticoagulants (warfarin and acenocumarine), low molecular weight heparin (LMWH) and anti-platelet (AP) drugs were considered.
Results: Out of 129 patients, 26 (20%) were treated with AC/AP drugs. Warfarin, acenocumarine, LMWH as well as AP were used in 7, 11 and 12 patients, respectively. Adverse events (bleeding) were observed in 3 patients (11.5%), 2 cases being on warfarin (replaced by LMWH) and 1 being AP (suspension without replacement); out of the 3 patients with bleeding, none presented thrombocytopenia.
Conclusions: Despite the frequent findings of hemostatic disorders in a population of frail patients managed in a home care setting, our experience demonstrated that the use of AC/AP drugs has been very rarely responsible for significant complications.


Keywords: Acenocumarine, Bleeding, Hematological malignancies, Low molecular weight heparin, Warfarin


How to cite this article:
Tendas A, Cupelli L, Scaramucci L, Palombi M, Trawinska MM, Giovannini M, Brunetti GA, Cartoni C, Bondanini F, de Fabritiis P, Niscola P. Anticoagulant and anti-thrombotic treatments in the management of hematological malignancies in a home care program. Indian J Palliat Care 2011;17:54-6

How to cite this URL:
Tendas A, Cupelli L, Scaramucci L, Palombi M, Trawinska MM, Giovannini M, Brunetti GA, Cartoni C, Bondanini F, de Fabritiis P, Niscola P. Anticoagulant and anti-thrombotic treatments in the management of hematological malignancies in a home care program. Indian J Palliat Care [serial online] 2011 [cited 2020 Aug 15];17:54-6. Available from: http://www.jpalliativecare.com/text.asp?2011/17/1/54/78450



 » Introduction Top


Anticoagulant (AC) and antiplatelet (AP) agents are widely used to manage thrombotic complications, which may be frequently observed in patients with hematological malignancies (HM). [1],[2],[3],[4] However, patients with HM may be at high risk of hemorrhagic complications due to different form of coagulopathies, several degrees of thrombocytopenia, and associated comorbidities. [5],[6] So that, the safe administration of these agents in this setting represents a matter of debate, also in the light of the paucity of data regarding this issue available in the medical literature. In this regard, we have performed a single-center prospective survey on a series of consecutive patients with HM in advanced phase of disease followed in a home care setting.


 » Materials and Methods Top


A prospective evaluation of the use of anticoagulant and anti-thrombotic agents, as well as the bleeding and thrombotic complications in a consecutive cohort of patients followed at home during the first semester of 2010 was performed. Three pharmacological class of agents, such as oral AC (warfarin and acenocumarine), low molecular weight heparin (LMWH) and AP drugs were considered. The indication for treatment, along with any significant adverse effects potentially referable to these agents, was evaluated. All treatments were given at home, where patients were followed by a specialized and multidisciplinary trained staff, composing seven hematologists, ten nurses, and several other care providers trained in hematology, palliative care and rehabilitation medicine. [7],[8],[9],[10] The availability at home of a reliable and trained caregiver was considered an essential condition to provide a home care program. [9] The home care team worked together with general services and diagnostic structures of our hospital; in the case of bleeding, all hemostatic measures, including platelet concentrates and fresh frozen plasma (FFP) transfusions, were supplied at home. [6]


 » Results Top


Demographic data and hematological diagnoses of patients included in the study are reported in [Table 1]. Out of 129 patients, 26 (20%) were treated with AC/AP drugs. Acenocumarine, warfarin, LMWH and AP were used in 7, 11 and 12 patients, respectively. Treatment indication, platelets count, coexisting renal or liver dysfunctions and drug dosage adjustment are reported on [Table 2]. Adverse events (bleeding) were observed in 3 (11.5%) out of 26 treated patients, being 2 of them on oral AC and 1 on AP; none of these 3 patients had thrombocytopenia.
Table 1: Demographic data and hematological diagnoses of patients followed during observation period


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Table 2. Treatment indication, platelets count, coexisting renal or liver failure, drug dosage modification in AC / AP patients


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 » Conclusions Top


In the management of patients with HM, thrombotic complications may represent a considerable concern, especially when they are in advanced phase of their disease and are followed at home. The incidence of these potentially devastating complications in patients with HM has been reported to be higher than that observed in the setting of solid tumors. Contributing factors include a HM-related thrombophilic state, some underlying disease activities and certain antineoplastic therapies, such as high dose corticosteroids, new immunomodulatory agents and hematopoietic growth factors. Primary and secondary pharmacological prophylaxis can be problematic in these patients, who are often concerned by thrombocytopenia, coagulopathies or co-existing diseases and organ dysfunctions for which a dosage adjustment of AC and AP drugs and a careful clinical monitoring are required. Our experience is referred to the activity of a home care services implemented in Rome, [7],[8],[9],[10] during the last two decades with the aim to offer highly developed expertise to several categories of patients with HM. In our experience, the home care represented an important added value in the global management of patients with deteriorated clinical conditions, social difficulties and physical impairments, achieving an integrated model of assistance and a cost-effective form of patient's care. [7] Despite the frequent findings of hemostatic disorders in this population of frail patients managed in a home care setting, our experience demonstrated that AC and AP drugs have been very rarely responsible for significant complications.

 
 » References Top

1.Wun T, White RH. Venous thromboembolism in patients with acute leukemia, lymphoma, and multiple myeloma. Thromb Res 2010;125:S96-102.   Back to cited text no. 1
    
2.Falanga A, Marchetti M. Venous thromboembolism in the hematologic malignancies. J Clin Oncol 2009;27:4848-57.   Back to cited text no. 2
    
3.Castelli R, Ferrari B, Cortelezzi A, Guariglia A. Thromboembolic complications in malignant haematological disorders. Curr Vasc Pharmacol 2010;8:482-94.  Back to cited text no. 3
    
4.Breccia M, Avvisati G, Latagliata R, Carmosino I, Guarini A, De Propris MS, et al. Occurrence of thrombotic events in acute promyelocytic leukemia correlates with consistent immunophenotypic and molecular features. Leukemia 2007;21:79-83.  Back to cited text no. 4
    
5.Avvisati G, Tirindelli MC, Annibali O. Thrombocytopenia and hemorrhagic risk in cancer patients. Crit Rev Oncol Hematol 2003;48:S13-6.  Back to cited text no. 5
    
6.Cartoni C, Niscola P, Breccia M, Brunetti G, D'Elia GM, Giovannini M, et al. Hemorrhagic complications in patients with advanced hematological malignancies followed at home: An Italian experience. Leuk Lymphoma 2009;50:387-91.  Back to cited text no. 6
    
7.Cartoni C, Brunetti GA, D'Elia GM, Breccia M, Niscola P, Marini MG, et al. Cost analysis of a domiciliary program of supportive and palliative care for patients with hematologic malignancies. Haematologica 2007;92:666-73.  Back to cited text no. 7
    
8.Niscola P, Cartoni C, Romani C, Brunetti GA, D'Elia GM, Cupelli L, et al. Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: An Italian survey. Ann Hematol 2007;86:671-6.  Back to cited text no. 8
    
9.Niscola P, de Fabritiis P, Cartoni C, Romani C, Sorrentino F, Dentamaro T, et al. Home care management of patients affected by hematologic malignancies: A review. Haematologica. 2006 Nov;91(11):1523-9.  Back to cited text no. 9
    
10.Niscola P, Cartoni C, de Fabritiis P, Foa` R, Mandelli F. Long term activity and ongoing development toward a new model of Home Care Organization in Rome: The ROMAIL-GIUSEPPE PAPA Home Hematological Hospital. Haematologica 2007;92:54a-5.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]

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