Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 1, pp 24–30 | Cite as

Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general hematologist–oncologists

  • Allyson M. Pishko
  • Mudi Misgav
  • Adam Cuker
  • Douglas B. Cines
  • James N. George
  • Sara K. Vesely
  • Deirdra R. Terrell


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.


Immune 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.

Ethical approval

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.

Supplementary material

11239_2018_1649_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 KB)
11239_2018_1649_MOESM2_ESM.xls (66 kb)
Supplementary material 2 (XLS 65 KB)


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of MedicinePerelman School of Medicine, University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.National Hemophilia Center, Sheba Medical CenterTel Aviv UniversityRamat-GanIsrael
  4. 4.Department of Medicine, College of MedicineUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  5. 5.Department of Biostatistics and Epidemiology, College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA

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