From the Guidelines
Anticoagulation in Thrombotic Microangiopathy (TMA) with Tumor
Anticoagulation is not routinely recommended for thrombotic microangiopathy (TMA) associated with tumor due to the high risk of bleeding complications.
- However, in select patients with TMA and tumor, anticoagulation with low-molecular-weight heparin (LMWH) such as enoxaparin 1mg/kg twice daily or unfractionated heparin 5000-10,000 units subcutaneously three times daily may be considered on a case-by-case basis 1.
- The decision to anticoagulate should be based on a careful assessment of the risk of thrombosis versus the risk of bleeding 1.
- The duration of anticoagulation therapy should be individualized, but typically ranges from 3 to 6 months, depending on the underlying tumor response to treatment and resolution of TMA.
- It is essential to monitor patients closely for signs of bleeding or thrombosis, and to adjust the anticoagulation regimen as needed 1.
- LMWH is preferred over unfractionated heparin for the initial 5 to 10 days of anticoagulation in patients with cancer and newly diagnosed VTE, due to its improved efficacy and safety profile 1.
From the Research
Anticoagulation in Thrombotic Microangiopathy (TMA) with Tumor
- The use of anticoagulation in TMA with tumor is a complex issue, and the decision to anticoagulate should be made on a case-by-case basis 2, 3.
- In some cases, anticoagulation with heparin may be contraindicated due to the risk of heparin-induced thrombocytopenia (HIT) 3.
- Alternative anticoagulants, such as lepirudin, may be used in patients with TMA and HIT 3.
- Eculizumab, a complement inhibitor, has been shown to be effective in treating chemotherapy-induced TMA 4.
- The use of targeted therapies, such as caplacizumab and eculizumab, may be considered in certain cases of TMA, but the decision to use these therapies should be made after careful consideration of the costs, side effects, and efficacy 5.
- In cases of pulmonary tumor thrombotic microangiopathy (PTTM), anticoagulation may not be effective, and the prognosis is generally poor 6.
Considerations for Anticoagulation
- The risk of bleeding and thrombosis should be carefully weighed when considering anticoagulation in patients with TMA and tumor 2, 3.
- The use of anticoagulation should be individualized based on the patient's underlying condition, the severity of the TMA, and the presence of other comorbidities 2, 3.
- Close monitoring of the patient's condition and laboratory parameters is essential when using anticoagulation in TMA with tumor 2, 3.