Risk Of Thrombosis In Elderly Immune Primary Trombocytopenic Patients Treated with Thrombopoietin Receptors Agonists
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LETTER TO THE EDITOR
Risk Of Thrombosis In Elderly Immune Primary Trombocytopenic Patients Treated with Thrombopoietin Receptors Agonists Roberto Castelli1 · Antonio Gidaro1 · Giorgio Lambertenghi Deliliers2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Highlights • Low platelet counts in patients with primary immune
thrombocytopenia (ITP) are associated with an increased risk for bleeding. • Paradoxically, patients with chronic ITP (c ITP) may also have an increased risk for venous thromboembolism (VTE) Few studies have evaluated the VTE risk in elderly c ITP patients compared with general population and in c ITP patients treated in second line therapy with thrombopoietin receptor agonists. • TPO‐RAs have significantly changed the management of ITP. Prospective randomized controlled studies demonstrated TPO‐RA efficacy in about 70% of adults with c ITP, with good short‐term safety profile. The two TPORA, romiplostim and eltrombopag, represent a completely different approach to ITP; they both have a very good chance of supporting the platelet count. Both drugs bind to the thrombopoietin (TPO) receptor, causing conformational change in the TPO receptor, activation of the JAK2/STAT5 pathway, and a resulting increased megakaryocyte progenitor proliferation and increased platelet production • Here we report our single center experience of treatment of ITP population in older patients focusing on thrombotic risk in elderly patients treated with thrombopoietin receptors agonist in c ITP. Data show that C ITP patients have an increased risk of thrombotic events as compared to general population and that c ITP patients exposed to
* Roberto Castelli [email protected] 1
Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
Fondazione Mattarelli, Milan, Italy
2
TPO RA have a slight but statistic significant increased risk of VTE • Physician should be aware that all available treatments for ITP have significant side‐effects and that their use is justified only if the patient has a real risk of bleeding, not just to correct platelet count toward normality, Treatment should be individualized, taking also into account the values of the patients, especially in elderly patients. Prophylaxis for thrombosis should be done in ITP patients in risky situations like immobilization and surgery (including splenectomy). Immune thrombocytopenic purpura (ITP) is an acquired autoimmune bleeding disorder characterized by a variable combination of peripheral platelet destruction and impaired platelet production [1, 2]. In patients with PTI, autoantibodies frequently appear to be directed against GpIb/IX and GPIIb/IIIa, although specificity for others platelet or megakaryocyte. Immune thrombocytopenic purpura (ITP) is an acquired autoimmune bleeding disorder characterized by a variable combination of peripheral platelet destruction and impaired platelet production [1, 2]. In patients with PTI, autoantibodies frequently appear to be directed
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