Can a patient with thrombocytopenia receive Mvasi (bevacizumab)?

Bevacizumab (Mvasi) Should Not Be Administered to Patients with Platelet Count Below 50 × 10⁹/L

Patients with thrombocytopenia with platelet counts below 50 × 10⁹/L should not receive bevacizumab (Mvasi) due to increased bleeding risk. 1

Thrombocytopenia and Bevacizumab Risk Assessment

Platelet Threshold Considerations

• The International Society on Thrombosis and Haemostasis recommends that full therapeutic doses of anticoagulants can be used only when platelet counts are >50 × 10⁹/L 2, 1
• For patients with platelet counts <50 × 10⁹/L, decisions must be made on a case-by-case basis with extreme caution due to bleeding risk 2
• Bevacizumab carries inherent bleeding risks as documented in its FDA label, including epistaxis, hemorrhage, and other bleeding complications 3

Bevacizumab-Specific Bleeding Risks

• Bevacizumab has been associated with several hematologic adverse events including:
  • Increased risk of thrombocytopenia (RR = 1.22) 4
  • Rare but documented cases of severe immune-mediated thrombocytopenia 5, 6, 7
  • Potential for thrombotic thrombocytopenic purpura 8

Management Algorithm for Patients with Thrombocytopenia Requiring Bevacizumab

1. For platelet count <50 × 10⁹/L:

   • Withhold bevacizumab administration
   • Consider platelet transfusion to increase platelet count if treatment is urgent
   • Monitor platelet count regularly

2. For platelet count 50-80 × 10⁹/L:

   • Proceed with caution
   • Implement close monitoring for bleeding signs
   • Consider dose reduction if clinically appropriate
   • Be vigilant for symptoms of bleeding (epistaxis, melena, petechiae)

3. For platelet count >80 × 10⁹/L:

   • Standard bevacizumab dosing can be used with regular monitoring

Special Considerations

Monitoring Requirements

• Regular platelet count monitoring before each dose of bevacizumab
• Assessment for clinical signs of bleeding (petechiae, purpura, epistaxis, melena)
• Immediate discontinuation if acute severe thrombocytopenia develops

Risk Factors for Increased Bleeding

• Concomitant anticoagulation therapy
• History of bleeding disorders
• Recent surgery
• Concurrent use of medications affecting platelet function

Important Caveats

• Case reports have documented rare but severe immune-mediated thrombocytopenia with bevacizumab that can occur rapidly after administration 5, 6
• Even with intravitreal administration (much lower systemic exposure), severe immune-mediated thrombocytopenia has been reported 7
• If bevacizumab is absolutely necessary in a patient with borderline platelet counts (50-80 × 10⁹/L), consider consultation with a hematologist before proceeding

The risk of bleeding complications with bevacizumab in the setting of thrombocytopenia must be carefully weighed against the potential benefits of therapy, with the understanding that a platelet count of 54 × 10⁹/L is just above the minimum threshold where administration might be considered.