Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general hematologist–oncologists
While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients. The survey described hypothetical patient scenarios and asked respondents to recommend a minimum platelet count for initiation of AP/AC therapy. We surveyed both hematologists with an international reputation in treatment of ITP (n = 48) and also general hematologist–oncologists in Oklahoma (n = 97). Response rates were 38/48 (79%) for the ITP specialists and 46/97 (47%) for general hematologist–oncologists. Overall, recommended platelet thresholds for antithrombotic therapy were similar between ITP specialists and general hematologist–oncologists. Although both groups recommended a minimum platelet count of 50 × 109/L for AP and AC therapy in most scenarios, there was great variability in individual practice patterns among respondents. This study highlights the need for studies of patients with ITP who require AP/AC therapy to provide high-quality evidence for establishing optimal management strategies.
KeywordsImmune thrombocytopenia ITP Antithrombotic therapy Anticoagulant therapy Antiplatelet therapy
This work was supported in part by 1K01HL135466-01 (DT) and T32 HL 0007971-16A1 (AP), both from the National Heart, Lung, and Blood Institute.
Compliance with ethical standards
Conflict of interest
AC has served as a consultant for Kedrion and Synergy and has received research support from Bayer, Bioverativ, Novo Nordisk, Pfizer, Shire, and Spark Therapeutics. DC has served as a consultant for Amgen, Bayer, Rigel, Astellas and Ionis and has received research support from Syntimmune, Momenta, T2 Biosystems and Sanofi.
All procedures performed in studies involving human participants were in accordance with the ethical standards or institution and/or national research committee and with the 1964 Helinski declaration and its later amendments or comparable ethical standards.
- 8.Sarpatwari A, Bennett D, Logie JW, Shukla A, Beach KJ, Newland AC, Sanderson S, Provan D (2010) Thromboembolic events among adult patients with primary immune thrombocytopenia in the United Kingdom General Practice Research Database. Haematologica 95(7):1167–1175. https://doi.org/10.3324/haematol.2009.018390 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Matzdorff A, Beer JH (2013) Immune thrombocytopenia patients requiring anticoagulation--maneuvering between Scylla and Charybdis. Semin Hematol 50(Suppl 1):S83–S88. https://doi.org/10.1053/j.seminhematol.2013.03.020 CrossRefPubMedGoogle Scholar
- 16.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010 CrossRefPubMedGoogle Scholar
- 18.Carrier M, Khorana AA, Zwicker J, Noble S, Lee AY (2013) Management of challenging cases of patients with cancer-associated thrombosis including recurrent thrombosis and bleeding: guidance from the SSC of the ISTH. J Thromb Haemost 11(9):1760–1765. https://doi.org/10.1111/jth.12338 CrossRefPubMedGoogle Scholar