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

Authors
  • Pishko, Allyson M.1
  • Misgav, Mudi2
  • Cuker, Adam1, 3
  • Cines, Douglas B.1, 3
  • George, James N.4, 5
  • Vesely, Sara K.5
  • Terrell, Deirdra R.5
  • 1 Perelman School of Medicine, University of Pennsylvania, Department of Medicine, Philadelphia, PA, USA , Philadelphia (United States)
  • 2 Tel Aviv University, National Hemophilia Center, Sheba Medical Center, Ramat-Gan, Israel , Ramat-Gan (Israel)
  • 3 University of Pennsylvania, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, USA , Philadelphia (United States)
  • 4 University of Oklahoma Health Sciences Center, Department of Medicine, College of Medicine, Oklahoma City, OK, USA , Oklahoma City (United States)
  • 5 University of Oklahoma Health Sciences Center, Department of Biostatistics and Epidemiology, College of Public Health, Oklahoma City, OK, USA , Oklahoma City (United States)
Type
Published Article
Journal
Journal of Thrombosis and Thrombolysis
Publisher
Springer-Verlag
Publication Date
Mar 26, 2018
Volume
46
Issue
1
Pages
24–30
Identifiers
DOI: 10.1007/s11239-018-1649-7
Source
Springer Nature
Keywords
License
Yellow

Abstract

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.

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