Thrombosis and anticoagulation: clinical issues of special importance to hematologists who practice in Asia
Issued Date
2022-12-09
Resource Type
ISSN
15204391
eISSN
15204383
Scopus ID
2-s2.0-85143917496
Pubmed ID
36485150
Journal Title
Hematology (United States)
Volume
2022
Issue
1
Start Page
474
End Page
480
Rights Holder(s)
SCOPUS
Bibliographic Citation
Hematology (United States) Vol.2022 No.1 (2022) , 474-480
Suggested Citation
Boonyawat K., Angchaisuksiri P. Thrombosis and anticoagulation: clinical issues of special importance to hematologists who practice in Asia. Hematology (United States) Vol.2022 No.1 (2022) , 474-480. 480. doi:10.1182/hematology.2022000383 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85175
Title
Thrombosis and anticoagulation: clinical issues of special importance to hematologists who practice in Asia
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
There are clinical issues of special importance and practice variation in the management of venous thromboembolism (VTE) and in the use of anticoagulants among hematologists who practice in Asia. In Asian-inherited thrombophilia, coagulation is disturbed due to loss-of-function mutations of protein S and protein C causing protein S and protein C deficiencies, whereas the gain-of-function factor V Leiden and prothrombin G20210A mutations are almost absent. Thrombophilia screening is not recommended in patients with VTE patients who have major provoking factors. However, it can be considered in unprovoked young patients with VTE who have a strong family history of VTE. Cancer is the most important acquired risk factor for VTE in Asians. Limited cancer screening at the initial presentation of unprovoked VTE is appropriate, especially in the elderly. Direct oral anticoagulants have been shown to have similar efficacy and reduce risk of major bleeding, including intracranial hemorrhage and bleeding requiring hospitalization, compared with warfarin. Most clinical trials evaluating therapies for treatment and prevention of VTE have included small numbers of Asian patients. Despite this lack of evidence, direct oral anticoagulants have been increasingly used in Asia for cancer-associated thrombosis. Individualized assessment of thrombotic and bleeding risks should be used for all hospitalized Asian patients when deciding on pharmacologic thromboprophylaxis. More research is needed to understand the factors that contribute to risks of VTE and anticoagulant-associated bleeding in Asian patients as these may differ from Western populations.