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

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.