Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH

Tzu-Fei Wang; Robert S Makar; Darko Antic; Jerrold H Levy; James D Douketis; Jean M Connors; Marc Carrier; Jeffrey I Zwicker

doi:10.1111/jth.15074

Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH

J Thromb Haemost. 2020 Dec;18(12):3174-3183. doi: 10.1111/jth.15074.

Authors

Tzu-Fei Wang¹, Robert S Makar², Darko Antic^{3

4}, Jerrold H Levy⁵, James D Douketis⁶, Jean M Connors⁷, Marc Carrier¹, Jeffrey I Zwicker⁸

Affiliations

¹ Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
² Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Clinic for Hematology, Clinical Center Serbia, Belgrade, Serbia.
⁴ School of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.
⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Division of Hematology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.

Abstract

Patients with acute leukemia frequently develop thrombocytopenia and hemostatic complications caused by coagulopathy. Coagulopathy complicates the management of these patients and can lead to significant morbidity and mortality. This guidance document aims to review and provide guidance on the management of hemostatic complications in adult patients with acute leukemia, addressing four main issues, including platelet transfusion, disseminated intravascular coagulation, L-asparaginase-related hypofibrinogenemia, and the use of antifibrinolytic agents.

Keywords: acute leukemia; guidance; hemostatic complications.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Adult
Antifibrinolytic Agents*
Disseminated Intravascular Coagulation* / diagnosis
Disseminated Intravascular Coagulation* / etiology
Disseminated Intravascular Coagulation* / therapy
Hemostatics* / therapeutic use
Humans
Leukemia, Myeloid, Acute*

Substances

Antifibrinolytic Agents
Hemostatics

Grants and funding

U01 HL143365/HL/NHLBI NIH HHS/United States