Management Practices for Asparaginase-associated Coagulopathy: A Survey of Pediatric Oncologists

Jacob R. Greenmyer, Kirk D. Wyatt, Vilmarie Rodriguez, Aneel A. Ashrani, Deepti Warad

Research output: Contribution to journalArticlepeer-review


Background: Coagulopathy and thrombosis are well-described complications of asparaginase therapy. However, treatment practices in pediatric hematology/oncology (PHO) patients vary widely as evidence-based guidelines for clinical management of these complications in this population are lacking. Objective: The objective of this study was to assess management practices of asparaginase-related coagulopathy by pediatric hematologist/oncologist attending physicians. Design/Method: Email survey sent to 2327 PHO physicians primarily practicing in the United States. Results: Two hundred 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 thirty (n=130/285, 45.6%) physicians replace low fibrinogen. The median fibrinogen replacement was 100 mg/dL (range: 40 to 200 mg/dL) with the median target of at least 100 mg/dL (range: 50 to 200 mg/dL). A minority of physicians (n=39/250, 13.7%) replace low antithrombin. The median antithrombin cutoff activity level was 60% (range: 40% to 100%) with a median target of 75% (range: 40% to 125%). Conclusions: There is a significant variation in PHO physician practices for monitoring and management of asparaginase-associated hemostatic derangements. Evidence-based guidelines have the potential to standardize practices.

Original languageEnglish (US)
Pages (from-to)E1023-E1028
JournalJournal of Pediatric Hematology/Oncology
Issue number8
StatePublished - Nov 1 2022


  • acute lymphoblastic leukemia
  • coagulopathy
  • pediatric
  • peg-asparaginase
  • thrombosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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