Low Platelet Counts in Cancer Patients: Should Heparin for Venous Thromboembolism Prophylaxis Be Instituted?

Abstract

and platelet levels of 18,000/mm 3 who developed an acute upper extremity deep vein thrombus. Although in her case, it was clearly related to a peripherally inserted central catheter in the affected limb, we wonder if it demonstrates her being at a considerably high risk for spontaneous thromboembolic events. The treating team could not gather sufficient evidence to institute prophylactic dosage of heparin in view of her high presumed risk of bleeding. Two out of the three majorrandomized,double-blind,placebo-controlledtrialsonthromboembolism prophylaxis in hospitalized patients (the Prophylaxis in Medical Patients with Enoxaparin trial and the Prevention of Recurrent Venous Thromboembolism study), have specifically excluded patients with platelet counts less than 100,000/mm 3 . 2,3 As such, evidence for thromboembolism prophylaxis in patients with platelet count less than 100,000/mm 3 is probably not clear.