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The immune thrombocytopenia paradox: Should we be concerned about thrombosis in ITP?
Saldanha, Artur; Colella, Marina Pereira; Villaça, Paula Ribeiro; Thachil, Jecko; Orsi, Fernanda Andrade.
Afiliação
  • Saldanha A; Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), Brazil; Hematology and Hemotherapy Center of Alagoas (HEMOAL), Brazil.
  • Colella MP; Hematology and Hemotherapy Center, Universidade Estadual de Campinas (UNICAMP), Brazil.
  • Villaça PR; Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), Brazil.
  • Thachil J; Department of Haematology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
  • Orsi FA; Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), Brazil; Department of Pathology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Brazil. Electronic address: ferorsi@unicamp.br.
Thromb Res ; 241: 109109, 2024 Sep.
Article em En | MEDLINE | ID: mdl-39137700
ABSTRACT
Despite the predisposition to bleeding, patients with immune thrombocytopenia (ITP) may also have an increased risk of arterial and venous thrombosis, which can contribute to significant morbidity. The risk of thrombosis increases with age and the presence of cardiovascular risk factors. This narrative review explores the multifactorial nature of thrombosis in ITP, focusing on new pathological mechanisms, emerging evidence on the association between established treatments and thrombotic risk, the role of novel treatment approaches, and the challenges in assessing the balance between bleeding and thrombosis in ITP. The review also explores the challenges in managing acute thrombotic events in ITP, since the platelet count does not always reliably predict either the risk of bleeding or thrombosis and antithrombotic strategies lack specific guidelines for ITP. Notably, second-line therapeutic options, such as splenectomy and thrombopoietin receptor agonists (TPO-RAs), exhibit an increased risk of thrombosis especially in older individuals or those with multiple thrombotic risk factors or previous thrombosis, emphasizing the importance of careful risk assessment before treatment selection. In this context, it is important to consider second-line therapies such as rituximab and other immunosuppressive agents, dapsone and fostamatinib, which are not associated with increased thrombotic risk. In particular, fostamatinib, an oral spleen tyrosine kinase inhibitor, has promisingly low thrombotic risk. During the current era of the emergence of several novel ITP therapies that do not pose additional risks for thrombosis, it is critical to outline evidence-based strategies for the prevention and treatment of thrombosis in ITP patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Trombose / Púrpura Trombocitopênica Idiopática Limite: Humans Idioma: En Revista: Thromb Res Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Trombose / Púrpura Trombocitopênica Idiopática Limite: Humans Idioma: En Revista: Thromb Res Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos