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Management practices for asparaginase-associated coagulopathy: a survey of pediatric oncologists
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  • Jacob Greenmyer,
  • Kirk Wyatt,
  • Vilmarie Rodriguez,
  • Aneel Ashrani,
  • Deepti Warad
Jacob Greenmyer
Mayo Clinic

Corresponding Author:jacob.greenmyer@und.edu

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Kirk Wyatt
Sanford Health
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Vilmarie Rodriguez
Nationwide Children's Hospital
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Aneel Ashrani
Mayo Clinic
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Deepti Warad
Mayo Clinic
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BACKGROUND: Coagulopathy and thrombosis are well-described complications of asparaginase therapy; however, treatment practices in pediatric hematology oncology patients vary widely as evidence-based guidelines for clinical management of these complications in this population are lacking. OBJECTIVE: To assess management practices of asparaginase-related coagulopathy by pediatric hematology oncology (PHO) providers. DESIGN/METHOD: Email survey sent to 2,327 PHO providers primarily practicing in the United States. RESULTS: Two hundred and eighty-five (12.2%) attending physicians completed the survey. Only 4.6% (n=13/285) routinely prescribe prophylactic anticoagulation during induction chemotherapy for leukemia. Slightly more than half (n=145/250, 50.9%) of all providers perform baseline coagulation studies. Most providers that were surveyed (n= 185/285, 64.9%) only replete coagulant factors if the patient experiences bleeding or bruising. One hundred and thirty (n = 130/285, 45.6%) physicians replace low fibrinogen, and the median replacement was 100 mg/dL (range: 40-200 mg/dL) with the median target of at least 100 mg/dL (range: 50-200 mg/dL). A minority of physicians (n=39/250, 13.7%) replace low antithrombin at a median cutoff activity level of 60% (range 40-100 %) with a median target of 75% (range: 40-125 %). CONCLUSION: There is a significant variation in PHO provider practices for monitoring and management of asparaginase-associated hemostatic derangements. Evidence-based guidelines have the potential to standardize practices.
Nov 2022Published in Journal of Pediatric Hematology/Oncology volume 44 issue 8 on pages e1023-e1028. 10.1097/MPH.0000000000002396