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<p>Cancer-associated thrombosis (CAT) with thrombocytopenia (TP) poses concurrent risks of bleeding and recurrence. Guidance is fragmented by nonuniform platelet thresholds, tumor-context effects on agent choice, and scarce prospective data for DOACs specifically in TP. We outline a platelet-count–adaptive framework: (i) standardized platelet bands linked to dose/agent actions; (ii) tumor-biology-aware selection; (iii) transfusion-sparing triggers; and (iv) a core outcome set that indexes events to time spent within platelet bands (“platelet-adjusted bleeding rate”). The schema is evidence-aligned, feasible in resource-constrained settings, and offers testable standards for pragmatic trials. Translating recent syntheses into implementable, equity-aware standards can reduce unwarranted variation and accelerate learning across diverse care settings.</p>

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Toward platelet-count–adaptive anticoagulation in cancer thrombocytopenia: a standards-first, equity-aware proposal

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • M. Vijayasimha

摘要

Cancer-associated thrombosis (CAT) with thrombocytopenia (TP) poses concurrent risks of bleeding and recurrence. Guidance is fragmented by nonuniform platelet thresholds, tumor-context effects on agent choice, and scarce prospective data for DOACs specifically in TP. We outline a platelet-count–adaptive framework: (i) standardized platelet bands linked to dose/agent actions; (ii) tumor-biology-aware selection; (iii) transfusion-sparing triggers; and (iv) a core outcome set that indexes events to time spent within platelet bands (“platelet-adjusted bleeding rate”). The schema is evidence-aligned, feasible in resource-constrained settings, and offers testable standards for pragmatic trials. Translating recent syntheses into implementable, equity-aware standards can reduce unwarranted variation and accelerate learning across diverse care settings.