Search

Background : The management of anticoagulation in patients with severe thrombocytopenia is challenging because of concerns regarding the risk of recurrent thrombosis if anticoagulation is withheld and bleeding if anticoagulation is continued. Aims : To evaluate local practice on the management of anticoagulation in hospital patients with thrombocytopenia and to evaluate their thrombotic and bleeding outcomes. Methods : A retrospective cohort study was conducted at a tertiary Australian hospital over 12 months. Patients with transient thrombocytopenia (platelet count <=50x10 9 /L for 3 to 14 days) were identified using the laboratory pathology system. Chart review was performed to identify corresponding patients with indications for therapeutic anticoagulation and to evaluate the anticoagulant management strategy during thrombocytopenia. History review was performed to identify the clinical outcomes of these patients. Results : We identified 147 patients with transient thrombocytopenia who had indications for therapeutic anticoagulation (n = 29) (Tables 1 and 2). Thrombosis occurred in 5 patients despite thrombocytopenia. Unexpectedly, a higher incidence of thrombosis was observed in the group receiving anticoagulation (26.7% vs. 7.1%; not statistically significant). However, among 4 patients that had thrombotic events on anticoagulation, 2 received heparin with a lower target APTT (within the therapeutic range) and 2 received therapeutic enoxaparin for only part of the thrombocytopenic period. Major bleeding occurred in 1 patient on anticoagulation. Conversely, six patients who received full anticoagulation did not experience bleeding or thrombosis. Conclusions : Our study demonstrates that patients with thrombocytopenia are still at risk of venous and arterial thrombosis. Additionally, therapeutic anticoagulation during thrombocytopenia can be administered without complication in some yet can result in both thrombosis and bleeding in others. No firm conclusions reg

Background : The management of anticoagulation in patients with severe thrombocytopenia is challenging because of concerns regarding the risk of recurrent thrombosis if anticoagulation is withheld and bleeding if anticoagulation is continued. Aims : To evaluate local practice on the management of anticoagulation in hospital patients with thrombocytopenia and to evaluate their thrombotic and bleeding outcomes. Methods : A retrospective cohort study was conducted at a tertiary Australian hospital over 12 months. Patients with transient thrombocytopenia (platelet count <=50x10 9 /L for 3 to 14 days) were identified using the laboratory pathology system. Chart review was performed to identify corresponding patients with indications for therapeutic anticoagulation and to evaluate the anticoagulant management strategy during thrombocytopenia. History review was performed to identify the clinical outcomes of these patients. Results : We identified 147 patients with transient thrombocytopenia who had indications for therapeutic anticoagulation (n = 29) (Tables 1 and 2). Thrombosis occurred in 5 patients despite thrombocytopenia. Unexpectedly, a higher incidence of thrombosis was observed in the group receiving anticoagulation (26.7% vs. 7.1%; not statistically significant). However, among 4 patients that had thrombotic events on anticoagulation, 2 received heparin with a lower target APTT (within the therapeutic range) and 2 received therapeutic enoxaparin for only part of the thrombocytopenic period. Major bleeding occurred in 1 patient on anticoagulation. Conversely, six patients who received full anticoagulation did not experience bleeding or thrombosis. Conclusions : Our study demonstrates that patients with thrombocytopenia are still at risk of venous and arterial thrombosis. Additionally, therapeutic anticoagulation during thrombocytopenia can be administered without complication in some yet can result in both thrombosis and bleeding in others. No firm conclusions reg

In summary, these results imply that the relationship of adiponectin with lipoproteins is more complex than previously predicted using other methods of lipoprotein fractionation. Higher correlation of adiponectin was shown with large lipoprotein particle size, independent of the apolipoprotein content. Given the small population studied, we could not assess the influence of mild risk factors for venous thrombosis, such as obesity, on the analysis of the results. Thus, we can only state that adiponectin levels appear not to be a strong risk factor for VTE. It is possible that adiponectin deficiency may contribute indirectly to the etiology of VTE by enhancing the inflammatory state. © 2006 International Society on Thrombosis and Haemostasis.