Bloody Minded Episode 72 - How low can you go? | Thrombosis & Thrombocytopenia with Dr Sara Ng
Dec 9, 2025
Dr. Sara Ng, a consultant haematologist specializing in thrombosis, tackles the challenging topic of managing thrombosis when platelet counts are dangerously low. She shares spine-tingling clinical cases, offering insights into acute conditions like pulmonary embolism and thrombocytopenia. Dr. Ng discusses anticoagulation strategies, the role of thrombectomy, and risks associated with IVC filters in cancer patients. Her practical approach emphasizes the importance of thorough assessments and prevention, making this discussion a must-listen for healthcare professionals.
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Support Platelets Before Treating Massive PE
- Transfuse platelets to a safe level (usually ≥50 x10^9/L) and give therapeutic anticoagulation for acute high-risk PE when platelets are very low.
- Prefer low molecular weight heparin initially unless logistics favour an unfractionated heparin infusion or intervention.
Prefer Thrombectomy Over Thrombolysis
- Consider thrombectomy for massive PE in thrombocytopenic patients rather than systemic thrombolysis because of bleeding risk.
- Use targeted clot extraction when available to reduce bleeding from metastatic or unknown sites.
Support Through First Month Then Reassess
- Provide platelet support through the highest-risk period (about the first month) while giving therapeutic anticoagulation for cancer-associated VTE.
- Reassess with imaging (CTPA) at ~4 weeks to guide ongoing anticoagulation.