Thromb Haemost 2019; 119(01): 163-174
DOI: 10.1055/s-0038-1676520
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Managing Anti-Platelet Therapy in Thrombocytopaenic Patients with Haematological Malignancy: A Multinational Clinical Vignette-Based Experiment

Avi Leader
1  Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
2  Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
3  Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Vincent Ten Cate
4  Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
,
Arina J. Ten Cate-Hoek
1  Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
5  Thrombosis Expert Center, Maastricht University Medical Center, Maastricht, The Netherlands
,
Galia Spectre
2  Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
3  Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Erik A. M. Beckers
6  Department of Hematology, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
,
Pia Raanani
2  Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
3  Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Cinzia Giaccherini
7  Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
,
David Pereg
3  Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
8  Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
,
Harry C. Schouten
6  Department of Hematology, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
,
Anna Falanga
7  Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
,
Hugo Ten Cate
1  Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
5  Thrombosis Expert Center, Maastricht University Medical Center, Maastricht, The Netherlands
› Author Affiliations
Further Information

Publication History

13 July 2018

25 October 2018

Publication Date:
31 December 2018 (online)

Abstract

Data on anti-platelet therapy (APT) for prevention of atherothrombotic events in thrombocytopaenic cancer patients is lacking. We aimed to identify patient and physician characteristics associated with APT management in thrombocytopaenic patients with haematological malignancy. A clinical vignette-based experiment was designed. Eleven haematologists were interviewed, identifying five variable categories. Next, 18 hypothetical vignettes were generated. Each physician received three vignettes and chose to: hold all APT; continue APT without platelet transfusion support; or continue APT with platelet transfusion support. The survey was distributed to haematologists and thrombosis specialists in three countries. Multivariate cluster robust Poisson regression models were used to calculate relative risks (RRs) of using one management option (over the other) for each variable in comparison to a reference variable. A total of 145 physicians answered 434 cases. Clinicians were more likely to hold APT in case of 20,000/µL platelets (vs. 40,000/µL; RR for continuing: 0.82 [95% confidence interval: 0.75–0.91]), recent major gastrointestinal bleeding (vs. none; RR 0.81 [0.72–0.92]) and when the physician worked at a university-affiliated community hospital (vs. non-academic community hospital; RR 0.84 [0.72–0.98]). Clinicians were more likely to continue APT in ST elevation myocardial infarction with dual APT (vs. unstable angina with single APT; RR 1.31 [1.18–1.45]) and when there were institutional protocols guiding management (vs. none; RR 1.15 [1.03–1.27]). When APT was continued, increased platelet transfusion targets were used in 34%. In summary, the decision process is complex and affected by multiple patient and physician characteristics. Platelet transfusions were frequently chosen to support APT, although no evidence supports this practice.

Supplementary Material