{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:21:40Z","timestamp":1791235300841,"version":"4.1.0"},"reference-count":75,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Thrombocytopenia is traditionally perceived as a bleeding-predominant condition; however, growing evidence indicates that many thrombocytopenic states are paradoxically associated with an increased risk of venous and arterial thrombosis. This dual hemostatic derangement poses major therapeutic challenges when anticoagulant or antiplatelet therapy is indicated, particularly in complex settings such as cancer-associated thrombosis, immune thrombocytopenia, and advanced liver disease. Methods: We conducted a narrative review of the literature published between January 2021 and May 2025 using PubMed and guideline repositories. Search terms included thrombocytopenia, anticoagulation, antiplatelet therapy, cancer-associated thrombosis, immune thrombocytopenia, and cirrhosis. International guidelines from ASH, ISTH, ASCO, EHA, ESC, and AHA were prioritized. Evidence was synthesized to define platelet-based safety thresholds and disease-specific management strategies. Results\/Discussion: Thrombocytopenia does not uniformly confer protection against thrombosis. Platelet activation, endothelial dysfunction, inflammatory signaling, impaired fibrinolysis, and procoagulant microparticles contribute to a prothrombotic milieu despite reduced platelet counts. Most guidelines support full-dose anticoagulation at platelet counts \u2265 50 \u00d7 109\/L, with dose modification between 25 and 50 \u00d7 109\/L and treatment interruption below 25 \u00d7 109\/L, depending on thrombotic risk. Antiplatelet therapy requires stricter individualization, particularly regarding dual antiplatelet therapy. Conclusions: Management of antithrombotic therapy in thrombocytopenic patients requires a dynamic, individualized approach balancing ischemic and bleeding risks. Pragmatic algorithms may guide clinical decision-making while prospective data remain limited.<\/jats:p>","DOI":"10.3390\/jcm15062273","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T09:35:57Z","timestamp":1773740157000},"page":"2273","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Navigating the Hemostatic Balance: Anticoagulation and Antiplatelet Therapy in Patients with Thrombocytopenia"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-855X","authenticated-orcid":false,"given":"Mar\u00eda-Eva","family":"Mingot-Castellano","sequence":"first","affiliation":[{"name":"Hematology Department, Molecular Diagnostics Department, Hospital Universitario Virgen del Roc\u00edo, Instituto de Biomedicina de Sevilla (IBIS\/CSIC), Universidad de Sevilla, 41013 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3296-4288","authenticated-orcid":false,"given":"Mar\u00eda Teresa","family":"\u00c1lvarez Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Hematology Department, La Paz University Hospital-IdiPaz, Universidad Aut\u00f3noma de Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8007-3909","authenticated-orcid":false,"given":"Jose Mar\u00eda","family":"Bastida","sequence":"additional","affiliation":[{"name":"Hematology Department, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca (IBSAL), Universidad de Salamanca (USAL), 37008 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4601-7150","authenticated-orcid":false,"given":"Nora","family":"Butta","sequence":"additional","affiliation":[{"name":"Bleeding and Haemostasis Disorders Group-IdiPAZ, Haematology and Haemotherapy Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6623-780X","authenticated-orcid":false,"given":"Gonzalo","family":"Caballero Navarro","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2875-9292","authenticated-orcid":false,"given":"Mariana","family":"Canaro Hirnyk","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Entrena Ure\u00f1a","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria del Carmen","family":"G\u00f3mez del Castillo Solano","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2151-2377","authenticated-orcid":false,"given":"Andres","family":"Ramirez Lopez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario de Toledo, 45007 Toledo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"S\u00e1nchez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hopital Parc de Salut Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8747-078X","authenticated-orcid":false,"given":"David","family":"Valcarcel Ferreira","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Pascual Izquierdo","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital General Universitario Gregorio Mara\u00f1on, Instituto de Investigaci\u00f3n Gregorio Mara\u00f1on, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Weycker, D., Hatfield, M., Grossman, A., Hanau, A., Lonshteyn, A., Sharma, A., and Chandler, D. 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