Feasibility and safety of delivering full‐dose anticoagulation therapy in children treated according to Dana‐Farber Cancer Institute acute lymphoblastic leukemia consortium therapy protocols

Background The literature is void of an evidence‐based anticoagulation therapy (ACT) management strategy in the context of thrombocytopenia. We examined the impact of thrombocytopenia on low‐molecular‐weight heparin (LMWH) dosing and incidence of bleeding in children with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LL) who developed thromboembolism (TE) during therapy according to DFCI ALL protocols. Procedure Patient records from our tertiary care center were reviewed for demographics, details of diagnoses and therapy of ALL/LL and TE diagnoses, platelet counts during ACT, LMWH dosing, and bleeding episodes. Results Thirty‐nine TEs were diagnosed in 33 patients [mean age 9 years (range, 2.5–18); 16 males and 31 with ALL] during the study period. A majority (85%) of patients were diagnosed with TE in the consolidation phase with mean time to TE 5.75 months from ALL/LL diagnosis. All patients received LMWH, and the median duration of ACT was 5.9 months (range, 1–11 months). Platelets were measured weekly. On 29 occasions, platelet nadir was