PLATELET INCREASING STRATEGIES IN PATIENTS WITH IMMUNE THROMBOCYTOPENIA REQUIRING LONG-TERM ANTITHROMBOTIC PROPHYLAXIS
(Abstract release date: 05/19/16)
EHA Library. De Stefano V. 06/09/16; 132973; E1424
Prof. Valerio De Stefano
Contributions
Contributions
Abstract
Abstract: E1424
Type: Eposter Presentation
Background
As in the general population, patients with immune thrombocytopenic purpura (ITP) can develop pathologies requiring long-term treatment with anticoagulant or antiplatelet agents. Challenging situations in this setting are antithrombotic prophylaxis in patients with atrial fibrillation (AF), artery stenosis, previous cardiac or vascular surgery, percutaneous transluminal coronary angioplasty (PTCA) with or without stenting, arterial or venous thrombosis. Concomitant use of platelet increasing treatment is mandatory for acceptable safety.
Aims
To summarize a monocenter experience in the management of ITP patients requiring long-term antithrombotic treatment and concomitant platelet increasing treatment.
Methods
We analysed the medical records of 108 ITP patients referred to our Center since 2000 to 2015; we identified 18 patients with risk situations making necessary platelet increasing treatments (M/F 11/7, median age at the treatment 52 yrs, range 47-90). Antithrombotic treatments were categorized as vitamin K-antagonists (VKA), direct oral anticoagulants (DOACs), low molecular weight heparin (LMWH), antiplatelet agents (aspirin, clopidogrel, indobufene). Platelet increasing treatments were categorized as prednisone (PDN), high-dose dexamethasone (DEX), high-dose immunoglobulins (HD-IG), thrombopoietin receptor agonists (TPO-RA: eltrombopag ETP, romiplostim RPL). A platelet count >100 x109/L or >30 x109/L in at least 4 consecutive weeks defined complete response (CR) or partial response (PR). Antithrombotic treatments were started at a platelet count higher than 50 x109/L.
Results
All patients had previously received at least one line of treatment (one line=4, two lines=7, three lines=4, > three lines=3); five patients had had splenectomy.Four patients had AF and received AVK (n=2), DOACs (n=1), LMWH (n=1); two had carotid stenosis and received aspirin; one underwent aortic valve replacement and received after surgery AVK and then aspirin; one underwent angioplasty of popliteal aspirin plus clopidogrel; one patient had coronary bypass and received indobufene; three patients had coronary stenting and received AVK (n=1) and aspirin plus clopidogrel (n=2); four patients had deep venous thrombosis of the legs and received LMWH for 6 to12 months; two patients had caval vein and portal vein thrombosis, respectively, and received VKA; one patient had retinal vein thrombosis and received LMWH. The median platelet count before the platelet increasing treatment was 46 x109/L (range 13-67). Twelve patients received TPO-RA (ETP=10; RPL=2), 3 patients received PDN, 2 patients received DEX, and one received HD-IG and PDN. Nine patients receiving TPO-RA achieved CR, and three PR (62, 91, and 99 x109/L); on the other hand four patients receiving steroids achieved CR, and one PR (88 x109/L). The remaining patient with caval vein thrombosis had no response after HD-IG and PDN and a caval filter was placed. All the other patients received antithrombotic treatment at therapeutic doses. No thrombotic or bleeding event was recorded after starting antithrombotic treatment together with a platelet increasing treatment.
Conclusion
Antithrombotic treatments can be given safely in patients with ITP after having obtained an increased platelet count. TPO-RA and steroids are both effective as platelet increasing strategies, but possible long-term side effects due to prolonged steroid treatment should induce caution.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP), Oral anticoagulant
Type: Eposter Presentation
Background
As in the general population, patients with immune thrombocytopenic purpura (ITP) can develop pathologies requiring long-term treatment with anticoagulant or antiplatelet agents. Challenging situations in this setting are antithrombotic prophylaxis in patients with atrial fibrillation (AF), artery stenosis, previous cardiac or vascular surgery, percutaneous transluminal coronary angioplasty (PTCA) with or without stenting, arterial or venous thrombosis. Concomitant use of platelet increasing treatment is mandatory for acceptable safety.
Aims
To summarize a monocenter experience in the management of ITP patients requiring long-term antithrombotic treatment and concomitant platelet increasing treatment.
Methods
We analysed the medical records of 108 ITP patients referred to our Center since 2000 to 2015; we identified 18 patients with risk situations making necessary platelet increasing treatments (M/F 11/7, median age at the treatment 52 yrs, range 47-90). Antithrombotic treatments were categorized as vitamin K-antagonists (VKA), direct oral anticoagulants (DOACs), low molecular weight heparin (LMWH), antiplatelet agents (aspirin, clopidogrel, indobufene). Platelet increasing treatments were categorized as prednisone (PDN), high-dose dexamethasone (DEX), high-dose immunoglobulins (HD-IG), thrombopoietin receptor agonists (TPO-RA: eltrombopag ETP, romiplostim RPL). A platelet count >100 x109/L or >30 x109/L in at least 4 consecutive weeks defined complete response (CR) or partial response (PR). Antithrombotic treatments were started at a platelet count higher than 50 x109/L.
Results
All patients had previously received at least one line of treatment (one line=4, two lines=7, three lines=4, > three lines=3); five patients had had splenectomy.Four patients had AF and received AVK (n=2), DOACs (n=1), LMWH (n=1); two had carotid stenosis and received aspirin; one underwent aortic valve replacement and received after surgery AVK and then aspirin; one underwent angioplasty of popliteal aspirin plus clopidogrel; one patient had coronary bypass and received indobufene; three patients had coronary stenting and received AVK (n=1) and aspirin plus clopidogrel (n=2); four patients had deep venous thrombosis of the legs and received LMWH for 6 to12 months; two patients had caval vein and portal vein thrombosis, respectively, and received VKA; one patient had retinal vein thrombosis and received LMWH. The median platelet count before the platelet increasing treatment was 46 x109/L (range 13-67). Twelve patients received TPO-RA (ETP=10; RPL=2), 3 patients received PDN, 2 patients received DEX, and one received HD-IG and PDN. Nine patients receiving TPO-RA achieved CR, and three PR (62, 91, and 99 x109/L); on the other hand four patients receiving steroids achieved CR, and one PR (88 x109/L). The remaining patient with caval vein thrombosis had no response after HD-IG and PDN and a caval filter was placed. All the other patients received antithrombotic treatment at therapeutic doses. No thrombotic or bleeding event was recorded after starting antithrombotic treatment together with a platelet increasing treatment.
Conclusion
Antithrombotic treatments can be given safely in patients with ITP after having obtained an increased platelet count. TPO-RA and steroids are both effective as platelet increasing strategies, but possible long-term side effects due to prolonged steroid treatment should induce caution.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP), Oral anticoagulant
Abstract: E1424
Type: Eposter Presentation
Background
As in the general population, patients with immune thrombocytopenic purpura (ITP) can develop pathologies requiring long-term treatment with anticoagulant or antiplatelet agents. Challenging situations in this setting are antithrombotic prophylaxis in patients with atrial fibrillation (AF), artery stenosis, previous cardiac or vascular surgery, percutaneous transluminal coronary angioplasty (PTCA) with or without stenting, arterial or venous thrombosis. Concomitant use of platelet increasing treatment is mandatory for acceptable safety.
Aims
To summarize a monocenter experience in the management of ITP patients requiring long-term antithrombotic treatment and concomitant platelet increasing treatment.
Methods
We analysed the medical records of 108 ITP patients referred to our Center since 2000 to 2015; we identified 18 patients with risk situations making necessary platelet increasing treatments (M/F 11/7, median age at the treatment 52 yrs, range 47-90). Antithrombotic treatments were categorized as vitamin K-antagonists (VKA), direct oral anticoagulants (DOACs), low molecular weight heparin (LMWH), antiplatelet agents (aspirin, clopidogrel, indobufene). Platelet increasing treatments were categorized as prednisone (PDN), high-dose dexamethasone (DEX), high-dose immunoglobulins (HD-IG), thrombopoietin receptor agonists (TPO-RA: eltrombopag ETP, romiplostim RPL). A platelet count >100 x109/L or >30 x109/L in at least 4 consecutive weeks defined complete response (CR) or partial response (PR). Antithrombotic treatments were started at a platelet count higher than 50 x109/L.
Results
All patients had previously received at least one line of treatment (one line=4, two lines=7, three lines=4, > three lines=3); five patients had had splenectomy.Four patients had AF and received AVK (n=2), DOACs (n=1), LMWH (n=1); two had carotid stenosis and received aspirin; one underwent aortic valve replacement and received after surgery AVK and then aspirin; one underwent angioplasty of popliteal aspirin plus clopidogrel; one patient had coronary bypass and received indobufene; three patients had coronary stenting and received AVK (n=1) and aspirin plus clopidogrel (n=2); four patients had deep venous thrombosis of the legs and received LMWH for 6 to12 months; two patients had caval vein and portal vein thrombosis, respectively, and received VKA; one patient had retinal vein thrombosis and received LMWH. The median platelet count before the platelet increasing treatment was 46 x109/L (range 13-67). Twelve patients received TPO-RA (ETP=10; RPL=2), 3 patients received PDN, 2 patients received DEX, and one received HD-IG and PDN. Nine patients receiving TPO-RA achieved CR, and three PR (62, 91, and 99 x109/L); on the other hand four patients receiving steroids achieved CR, and one PR (88 x109/L). The remaining patient with caval vein thrombosis had no response after HD-IG and PDN and a caval filter was placed. All the other patients received antithrombotic treatment at therapeutic doses. No thrombotic or bleeding event was recorded after starting antithrombotic treatment together with a platelet increasing treatment.
Conclusion
Antithrombotic treatments can be given safely in patients with ITP after having obtained an increased platelet count. TPO-RA and steroids are both effective as platelet increasing strategies, but possible long-term side effects due to prolonged steroid treatment should induce caution.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP), Oral anticoagulant
Type: Eposter Presentation
Background
As in the general population, patients with immune thrombocytopenic purpura (ITP) can develop pathologies requiring long-term treatment with anticoagulant or antiplatelet agents. Challenging situations in this setting are antithrombotic prophylaxis in patients with atrial fibrillation (AF), artery stenosis, previous cardiac or vascular surgery, percutaneous transluminal coronary angioplasty (PTCA) with or without stenting, arterial or venous thrombosis. Concomitant use of platelet increasing treatment is mandatory for acceptable safety.
Aims
To summarize a monocenter experience in the management of ITP patients requiring long-term antithrombotic treatment and concomitant platelet increasing treatment.
Methods
We analysed the medical records of 108 ITP patients referred to our Center since 2000 to 2015; we identified 18 patients with risk situations making necessary platelet increasing treatments (M/F 11/7, median age at the treatment 52 yrs, range 47-90). Antithrombotic treatments were categorized as vitamin K-antagonists (VKA), direct oral anticoagulants (DOACs), low molecular weight heparin (LMWH), antiplatelet agents (aspirin, clopidogrel, indobufene). Platelet increasing treatments were categorized as prednisone (PDN), high-dose dexamethasone (DEX), high-dose immunoglobulins (HD-IG), thrombopoietin receptor agonists (TPO-RA: eltrombopag ETP, romiplostim RPL). A platelet count >100 x109/L or >30 x109/L in at least 4 consecutive weeks defined complete response (CR) or partial response (PR). Antithrombotic treatments were started at a platelet count higher than 50 x109/L.
Results
All patients had previously received at least one line of treatment (one line=4, two lines=7, three lines=4, > three lines=3); five patients had had splenectomy.Four patients had AF and received AVK (n=2), DOACs (n=1), LMWH (n=1); two had carotid stenosis and received aspirin; one underwent aortic valve replacement and received after surgery AVK and then aspirin; one underwent angioplasty of popliteal aspirin plus clopidogrel; one patient had coronary bypass and received indobufene; three patients had coronary stenting and received AVK (n=1) and aspirin plus clopidogrel (n=2); four patients had deep venous thrombosis of the legs and received LMWH for 6 to12 months; two patients had caval vein and portal vein thrombosis, respectively, and received VKA; one patient had retinal vein thrombosis and received LMWH. The median platelet count before the platelet increasing treatment was 46 x109/L (range 13-67). Twelve patients received TPO-RA (ETP=10; RPL=2), 3 patients received PDN, 2 patients received DEX, and one received HD-IG and PDN. Nine patients receiving TPO-RA achieved CR, and three PR (62, 91, and 99 x109/L); on the other hand four patients receiving steroids achieved CR, and one PR (88 x109/L). The remaining patient with caval vein thrombosis had no response after HD-IG and PDN and a caval filter was placed. All the other patients received antithrombotic treatment at therapeutic doses. No thrombotic or bleeding event was recorded after starting antithrombotic treatment together with a platelet increasing treatment.
Conclusion
Antithrombotic treatments can be given safely in patients with ITP after having obtained an increased platelet count. TPO-RA and steroids are both effective as platelet increasing strategies, but possible long-term side effects due to prolonged steroid treatment should induce caution.
Session topic: E-poster
Keyword(s): Immune thrombocytopenia (ITP), Oral anticoagulant
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