Aspirin use and bleeding events during thrombocytopenia after autologous stem-cell transplantation for multiple myeloma

Nina Rosa Neuendorff; Boryana Boshikova; Lutz Frankenstein; Marietta Kirchner; Christian Rohde; Hartmut Goldschmidt; Norbert Frey; Carsten Müller-Tidow; Karin Jordan; Sandra Sauer; Maike Janssen

doi:10.3389/fonc.2023.1168120

Aspirin use and bleeding events during thrombocytopenia after autologous stem-cell transplantation for multiple myeloma

Front Oncol. 2023 Apr 27:13:1168120. doi: 10.3389/fonc.2023.1168120. eCollection 2023.

Authors

Affiliations

¹ Department of Medicine V-Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
² Department of Hematology and Stem-Cell Transplantation, University Hospital Essen, Essen, Germany.
³ Clinic for Cardiology and General Internal Medicine, Städtisches Klinikum Solingen gemeinnützige GmbH, Solingen, Germany.
⁴ Department of Medicine III-Cardiology, Angiology and Intensive Care, University Hospital Heidelberg, Heidelberg, Germany.
⁵ Institute of Medical Biometry (IMBI), University Hospital Heidelberg, Heidelberg, Germany.
⁶ Klinikum Ernst von Bergmann-Department for Hematology, Oncology and Palliative Care, Potsdam, Germany.

Abstract

Background: In patients with cardiovascular (CV) comorbidities that necessitate antiplatelet therapy (APT), its optimal management during chemotherapy-induced thrombocytopenia remains elusive, as the risk of bleeding has to be balanced against the risk of CV events. The purpose of this study was to assess the risk for bleeding with APT during thrombocytopenia in patients with multiple myeloma undergoing high-dose chemotherapy and subsequent autologous stem-cell transplantation (ASCT) with and without acetylsalicylic acid (ASA) as comedication.

Methods: We assessed patients who underwent ASCT at the Heidelberg University Hospital between 2011 and 2020 for bleeding events, management strategies for ASA intake during thrombocytopenia, transfusion requirements, and the occurrence of CV events.

Results: There were 57/1,113 patients who continued ASA until at least 1 day after ASCT; thus, a continuous platelet inhibition during thrombocytopenia was assumed. Most of the patients (41/57) continued ASA until they had a platelet count of 20-50/nl. This range reflects the kinetics of thrombocytopenia and nondaily measurements of platelets during ASCT. A tendency toward a higher risk for bleeding events in the ASA group was demonstrated (1.9% (control group) vs. 5.3% (ASA), p = 0.082). The risk factors for bleeding in multivariate analysis were the duration of thrombocytopenia < 50/nl, a history of gastrointestinal bleeding, and diarrhea. The factors predicting the duration of thrombocytopenia were age >60 years, a hematopoietic stem-cell transplantation comorbidity index ≥3, and an impaired bone marrow reserve at admission. CV events occurred in three patients; none of them took ASA or had an indication for APT.

Conclusions: The intake of ASA until thrombocytopenia with a platelet count of 20-50/nl appears safe, although an elevated risk cannot be excluded. If ASA is indicated for the secondary prevention of CV events, the evaluation of risk factors for bleeding and a prolonged time of thrombocytopenia before conditioning is crucial to adapt the strategy for ASA intake during thrombocytopenia.

Keywords: antiplatelet therapy; aspirin; autologous stem-cell transplantation; bleeding; cardio-vascular events; multiple myeloma.

Grants and funding

This work was supported by Deutsche Forschungsgemeinschaft (DFG) in the framework of the DFG University Medicine Essen Clinician Scientist Academy (UMEA), FU 356/12-2 to NN.