Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis

Thromb Res. 2023 Jul:227:8-16. doi: 10.1016/j.thromres.2023.05.012. Epub 2023 May 11.


Background: Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients.

Methods: We searched MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 5, 2022. Studies assessing adult patients with cancer-associated thrombosis and platelet count <100 × 109/L were included. Three anticoagulation management strategies were reported: full dose, modified dose, or no anticoagulation. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates of thrombotic and bleeding outcomes by anticoagulation management strategies were descriptive, and were pooled using random effects model and expressed as events per 100 patient-months with associated 95 % confidence intervals (CI).

Results: We included 19 observational cohort studies (N = 1728 patients) in the systematic review, with 10 included in the meta-analysis (N = 707 patients). Approximately 90 % of patients had hematological malignancies, with low-molecular-weight heparin being the main anticoagulant. The rates of recurrent VTE and bleeding complications were high regardless of management strategies - recurrent VTE on full dose: 2.65/100 patient-months (95 % CI 1.62-4.32), modified dose: 3.51/100 patient-months (95 % CI 1.00-12.39); major bleeding on full dose: 4.45/100 patient-months (95 % CI 2.80-7.06), modified dose: 4.16/100 patient-months (95 % CI 2.24-7.74). There was serious risk of bias in all studies.

Conclusions: Patients with cancer-associated thrombosis and thrombocytopenia have high risks of both recurrent VTE and major bleeding, but current literature is significantly limited to guide the best management.

Keywords: Anticoagulation; Malignancy; Systematic review; Thrombocytopenia; cancer-associated thrombosis; meta-analysis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Anticoagulants / adverse effects
  • Hemorrhage / chemically induced
  • Heparin, Low-Molecular-Weight / adverse effects
  • Humans
  • Neoplasm Recurrence, Local / chemically induced
  • Neoplasm Recurrence, Local / complications
  • Thrombocytopenia* / chemically induced
  • Thrombocytopenia* / complications
  • Thrombocytopenia* / drug therapy
  • Thrombosis* / chemically induced
  • Thrombosis* / etiology
  • Venous Thromboembolism* / chemically induced
  • Venous Thromboembolism* / etiology


  • Anticoagulants
  • Heparin, Low-Molecular-Weight