The prevention and management of asparaginase-related venous thromboembolism in adults: Guidance from the SSC on Hemostasis and Malignancy of the ISTH

Jeffrey I Zwicker; Tzu-Fei Wang; Daniel J DeAngelo; Mandy N Lauw; Jean M Connors; Anna Falanga; Malgorzata McMasters; Marc Carrier

doi:10.1111/jth.14671

The prevention and management of asparaginase-related venous thromboembolism in adults: Guidance from the SSC on Hemostasis and Malignancy of the ISTH

J Thromb Haemost. 2020 Feb;18(2):278-284. doi: 10.1111/jth.14671.

Authors

Jeffrey I Zwicker¹, Tzu-Fei Wang², Daniel J DeAngelo³, Mandy N Lauw^{4

5

6}, Jean M Connors⁷, Anna Falanga^{8

9}, Malgorzata McMasters¹⁰, Marc Carrier¹¹

Affiliations

¹ Division of Hematology and Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA.
³ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁴ Department of Hematology, Erasmus MC, Rotterdam, the Netherlands.
⁵ Department of Hematology, Amsterdam UMC, Amsterdam, the Netherlands.
⁶ Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands.
⁷ Hematology Division, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
⁸ University of Milan Bicocca, Milan, Italy.
⁹ Hospital Papa Giovanni XXIII, Bergamo, Italy.
¹⁰ Division of Hematologic Malignancies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, ON, Canada.

PMID: 31999063
DOI: 10.1111/jth.14671

Abstract

Venous thromboembolism is a common complication of asparaginase-based chemotherapy regimens for the treatment of acute lymphoblastic leukemia. Thrombosis associated with asparaginase administration poses a number of specific and often clinically challenging management decisions. This review provides guidance on the prevention and treatment of thrombosis associated with asparaginase in adults including discussions on antithrombin repletion, pharmacologic thromboprophylaxis, cerebral venous thrombosis, and therapeutic anticoagulation.

Keywords: acute lymphoblastic leukemia; anticoagulation; antithrombin; asparaginase; cerebral venous thrombosis; venous thromboembolism.

Publication types

Review

MeSH terms

Adult
Anticoagulants / adverse effects
Antithrombins
Asparaginase / adverse effects
Humans
Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
Venous Thromboembolism* / diagnosis
Venous Thromboembolism* / drug therapy
Venous Thromboembolism* / prevention & control

Substances

Anticoagulants
Antithrombins
Asparaginase