loading page

Management practices for asparaginase-associated coagulopathy: a survey of pediatric oncologists
  • +2
  • Jacob Greenmyer,
  • Kirk Wyatt,
  • Vilmarie Rodriguez,
  • Aneel Ashrani,
  • Deepti Warad
Jacob Greenmyer
Mayo Clinic
Author Profile
Kirk Wyatt
Sanford Health
Author Profile
Vilmarie Rodriguez
Nationwide Children's Hospital
Author Profile
Aneel Ashrani
Mayo Clinic
Author Profile
Deepti Warad
Mayo Clinic
Author Profile

Abstract

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.