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Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: A retrospective multicentre study

Internal Medicine Journal Sep 18, 2019

Le Guenno G, Guieze R, Audia S, et al. - Via a retrospective study of 49 patients with immune thrombocytopenic purpura (ITP) and venous thromboembolic events (VTE) registered in databases of three reference French centers of ITP, researchers defined VTE and ITP features, distribution of VTE risk factors and their influence on VTE characteristics and recurrence. A total of 66 VTE were recorded. For 28/43 patients, the platelet count at the time of the first VTE was < 100 × 109/L. At least one positive antiphospholipid test result was noted in a total of 19/48 patients. For the 10 VTE happening in eight patients with platelet count < 50 × 109/L, ITP treatment was effective in 7. One hemorrhagic complication correlated with anticoagulant (AC) therapy was noted. For 31/49 patients, long-term AC therapy could have been discussed following the first VTE, but only 13 got it. In 13 patients, a second VTE occurred. The risk of recurrence was raised in patients with unprovoked VTE prior to the ITP diagnosis or active cancer. Thus, VTE in ITP mainly occurred in the presence of various risk factors of TE. A low platelet count does not defend against VTE. Management with AC therapy notwithstanding constantly low platelet count appears possible. The risk of VTE recurrence is high, especially with a history of unprovoked VTE or active cancer. In this setting, indefinite AC therapy could be addressed.
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