Management of Vascular Thrombosis in Patients with Thrombocytopenia

Abstract

Platelets play critical roles in hemostasis and thrombosis. While low platelet counts increase the risk of bleeding, antithrombotic drugs, including anticoagulants and antiplatelet agents, are used to treat thromboembolic events. Thus, the management of thrombosis in patients with low platelet counts is challenging with hardly any evidence available to guide treatment. Recognition of the underlying cause of thrombocytopenia is essential for assessing the bleeding risk and tailoring therapeutic options. A typical clinical scenario is the occurrence of venous thromboembolism (VTE) in cancer patients experiencing transient thrombocytopenia during myelosuppressive chemotherapy. In such patients, the severity of thrombocytopenia, thrombus burden, clinical symptoms, and the timing of VTE relative to thrombocytopenia must be considered. In clinical practice, distinct hematological disorders characterized by low platelet counts and a thrombogenic state require specific diagnostics and treatment. These include the antiphospholipid syndrome, heparin-induced thrombocytopenia (HIT) and (spontaneous) HIT syndromes, disseminated intravascular coagulation, and paroxysmal nocturnal hemoglobinuria.

Zusammenfassung

Thrombozyten spielen in der Hämostase und Thrombose eine zentrale Rolle. Während niedrige Plättchenzahlen das Blutungsrisiko steigern, werden Antithrombotika wie Antikoagulantien oder Aggregationshemmer standardmäßig zur Therapie von Thromboembolien eingesetzt. Aus diesem Grund stellt die Thrombosebehandlung bei thrombozytopenen Patienten eine besondere Herausforderung dar. Für die Einschätzung des Blutungsrisikos und die gezielte Auswahl therapeutischer Maßnahmen ist die Kenntnis der Ursache einer Thrombozytopenie entscheidend. Ein typisches Szenario ist das Auftreten einer venösen Thromboembolie (VTE) bei Krebspatienten unter myelosuppressiver Chemotherapie. In dieser Situation müssen Ausmaß der Thrombozytopenie, Thrombuslast, klinische Symptome und zeitlicher Abstand zwischen VTE-Diagnose und Plättchenabfall berücksichtigt werden. Im klinischen Alltag erfordern bestimmte hämatologische Erkrankungen, die mit Thrombozytopenie und Thromboseneigung einhergehen, einer spezifischen Diagnostik und Therapie, z.B. Antiphospholipidsyndrom, heparininduzierte Thrombozytopenie (HIT), (spontane) HIT-Syndrome, disseminierte intravasale Gerinnung oder paroxysmale nächtliche Hämoglobinurie.

Keywords

thrombosis - bleeding - thrombocytopenia - anticoagulation - platelet inhibition

Schlüsselwörter

Thrombose - Blutung - Thrombozytopenie - Antikoagulation - Plättchenhemmung

Publikationsverlauf

Eingereicht: 16. August 2021

Angenommen: 18. Oktober 2021

Artikel online veröffentlicht:
21. Dezember 2021

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