Subjects:
Clinical Trials and Observations, Platelets and Thrombopoiesis

TO THE EDITOR:

The median age at immune thrombocytopenia (ITP) diagnosis in adult patients is ≈60 years,1,2 and ITP is not protective against thrombosis.3 Therefore, a significant proportion of adult patients with ITP are exposed to antiplatelet drugs,4 which is particularly challenging in clinical practice in regard to the risk of bleeding. In 2019, international guidelines for the management of ITP stated that a dedicated treatment is rarely indicated in case of platelet count >20 × 109/L.5 The threshold associated with significant bleeding in patients with ITP treated with antiplatelet agents is unknown.6 The international consensus recommended a platelet count target ≥30 × 109/L to 50 × 109/L in patients with ITP treated with a single antiplatelet agent, and a platelet count target ≥50 × 109/L...

1.
Schoonen
WM
,
Kucera
G
,
Coalson
J
, et al.
Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database
.
Br J Haematol
.
2009
. ;
145
(
2
):
235
-
244
.
Google Scholar
Crossref
Search ADS
PubMed
 
2.
Moulis
G
,
Palmaro
A
,
Montastruc
J-L
,
Godeau
B
,
Lapeyre-Mestre
M
,
Sailler
L
.
Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France
.
Blood
.
2014
. ;
124
(
22
):
3308
-
3315
.
Google Scholar
Crossref
Search ADS
PubMed
 
3.
Swan
D
,
Newland
A
,
Rodeghiero
F
,
Thachil
J
.
Thrombosis in immune thrombocytopenia - current status and future perspectives
.
Br J Haematol
.
2021
. ;
194
(
5
):
822
-
834
.
Google Scholar
Crossref
Search ADS
PubMed
 
4.
Lafaurie
M
,
Maquet
J
,
Baricault
B
, et al.
Risk factors of hospitalisation for thrombosis in adults with primary immune thrombocytopenia, including disease-specific treatments: a French nationwide cohort study
.
Br J Haematol
.
2021
. ;
195
(
3
):
456
-
465
.
Google Scholar
Crossref
Search ADS
PubMed
 
5.
Provan
D
,
Arnold
DM
,
Bussel
JB
, et al.
Updated international consensus report on the investigation and management of primary immune thrombocytopenia
.
Blood Adv
.
2019
. ;
3
(
22
):
3780
-
3817
.
Google Scholar
Crossref
Search ADS
PubMed
 
6.
Pishko
AM
,
Misgav
M
,
Cuker
A
, et al.
Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general hematologist-oncologists
.
J Thromb Thrombolysis
.
2018
. ;
46
(
1
):
24
-
30
.
Google Scholar
Crossref
Search ADS
 
7.
Neunert
C
,
Terrell
DR
,
Arnold
DM
, et al.
American Society of Hematology 2019 guidelines for immune thrombocytopenia
.
Blood Adv
.
2019
. ;
3
(
23
):
3829
-
3866
.
Google Scholar
Crossref
Search ADS
PubMed
 
8.
Moulis
G
,
Germain
J
,
Comont
T
, et al.
Newly diagnosed immune thrombocytopenia adults: clinical epidemiology, exposure to treatments, and evolution: results of the CARMEN multicenter prospective cohort
.
Am J Hematol
.
2017
. ;
92
(
6
):
493
-
500
.
Google Scholar
Crossref
Search ADS
PubMed
 
9.
Rodeghiero
F
,
Stasi
R
,
Gernsheimer
T
, et al.
Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group
.
Blood
.
2009
. ;
113
(
11
):
2386
-
2393
.
Google Scholar
Crossref
Search ADS
PubMed
 
10.
Piel-Julian
M-L
,
Mahévas
M
,
Germain
J
, et al.
Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults
.
J Thromb Haemostasis
.
2018
. ;
16
(
9
):
1830
-
1842
.
Google Scholar
Crossref
Search ADS
 
11.
Adelborg
K
,
Kristensen
NR
,
Nørgaard
M
, et al.
Cardiovascular and bleeding outcomes in a population-based cohort of patients with chronic immune thrombocytopenia
.
J Thromb Haemostasis
.
2019
. ;
17
(
6
):
912
-
924
.
Google Scholar
Crossref
Search ADS
 
12.
Schmidt
M
,
Lamberts
M
,
Olsen
A-MS
, et al.
Cardiovascular safety of non-aspirin non-steroidal anti-inflammatory drugs: review and position paper by the Working Group for Cardiovascular Pharmacotherapy of the European Society of Cardiology
.
Eur Heart J Cardiovasc Pharmacother
.
2016
. ;
2
(
2
):
108
-
118
.
Google Scholar
Crossref
Search ADS
PubMed
 
13.
Dragani
A
,
Pascale
S
,
Recchiuti
A
, et al.
The contribution of cyclooxygenase-1 and -2 to persistent thromboxane biosynthesis in aspirin-treated essential thrombocythemia: implications for antiplatelet therapy
.
Blood
.
2010
. ;
115
(
5
):
1054
-
1061
.
Google Scholar
Crossref
Search ADS
PubMed
 
14.
Moulis
G
,
Cooper
N
,
Ghanima
W
, et al.
Registries in immune thrombocytopenia (ITP) in Europe: the European Research Consortium on ITP (ERCI) network
.
Br J Haematol
.
2022
. ;
197
(
5
):
633
-
638
.
Google Scholar
Crossref
Search ADS
PubMed
 
15.
Sokal
A
,
de Nadaï
T
,
Maquet
J
, et al.
Primary immune thrombocytopenia in very elderly patients: particularities in presentation and management: results from the prospective CARMEN-France Registry
.
Br J Haematol
.
2022
. ;
196
(
5
):
1262
-
1270
.
Google Scholar
Crossref
Search ADS
PubMed
 
© 2023 by The American Society of Hematology
2023
© 2023 by The American Society of Hematology
2023
You do not currently have access to this content.
Sign in via your Institution