Sarkiss MG et al. (2007) Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes. Cancer 109: 621–627

The benefits of aspirin therapy in patients with acute coronary syndromes (ACS) have been well documented. AHA/ACC guidelines recommend aspirin in all cases of ACS; however, it has been suggested that the bleeding risks associated with aspirin might outweigh the benefits of this therapy in patients with thrombocytopenia. Sarkiss et al. have evaluated aspirin therapy in cancer patients with ACS and thrombocytopenia secondary to chemotherapy or bone marrow suppression.

The authors retrospectively reviewed the records of 70 patients with cancer who had been diagnosed with ACS and referred for cardiology consultation. The 27 patients with thrombocytopenia (platelet counts ≤1.0 × 1011/l) had worse 7-day survival than the 43 patients without thrombocytopenia (37% vs 77%; P = 0.0012). Among the nonthrombocytopenic patients, aspirin therapy was associated with improved 7-day survival compared with no aspirin therapy (88% vs 45%; P = 0.0096). Notably, aspirin therapy was also associated with better 7-day survival in those patients with thrombocytopenia (90% vs 6%; P <0.0001). No major adverse bleeding events were observed; minor bleeding was seen in 12 patients, but was not associated with aspirin use.

Aspirin could, therefore, be beneficial in cancer patients with ACS with or without thrombocytopenia. The authors also report similar observed benefits of β-blocker use on 7-day survival in patients with and without thrombocytopenia. They do warn, however, that clinicians should consider individual cases carefully, as the potential for serious bleeding complications in thrombocytopenia remains high.