Thrombosis in Acute Myeloid Leukemia: Pathogenesis, Risk Factors and Therapeutic Challenges.

Abstract

OPINION STATEMENT:

Prophylaxis and treatment of thrombosis in leukemic patients still represent a major challenge with several clinical questions yet to be solved. Indeed, the paucity of evidence makes the management of venous thromboembolic events difficult and not uniform. Due to thrombocytopenia, patients with acute myeloid leukemia (AML) are underrepresented in trials investigating prophylaxis and treatment of thrombosis in cancer, and prospective data are lacking. Likewise, the therapeutic approach with anti-coagulants in leukemic patients is inferred from guidelines originally developed in the solid cancer setting and clear recommendations in the thrombocytopenic population are limited. Importantly, the discrimination of patients at high risk of bleeding from those with a predominant risk of thrombosis remains extremely difficult with no predictive score validated so far. Thus, the management of thrombosis often relies on clinician experience, and it is tailored to the individual patient, constantly balancing thrombotic and hemorrhagic risks. Who would benefit from primary prophylaxis and how a thrombotic event should be appropriately treated are some of the unanswered questions that the future guidelines and trials should address. Moreover, a greater effort should be made to identify robust predictive factors able to guide clinicians in the management of this potential serious complication for AML patients.

• Authors: Matteo Olivi, Federica Di Biase, Giuseppe Lanzarone, Giulia Arrigo, Federica Martella, Vincenzo Apolito, Carolina Secreto, Roberto Freilone, Benedetto Bruno, Ernesta Audisio, Dario Ferrero, Eloise Beggiato, Marco Cerrano
• Journal: Current treatment options in oncology (Curr Treat Options Oncol) Vol. 24 Issue 6 Pg. 693-710 (06 2023) ISSN: 1534-6277 [Electronic] United States
• PMID: 37099265 (Publication Type: Journal Article, Review)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Anticoagulants

Topics

• Humans
• Anticoagulants (adverse effects)
• Prospective Studies
• Thrombosis (diagnosis, etiology, prevention & control)
• Leukemia, Myeloid, Acute (complications, diagnosis)
• Venous Thromboembolism (diagnosis, etiology, prevention & control)
• Risk Factors