A new review published in the European Journal of Haematology describes the challenges inherent in managing both bleeding and excessive clot risk in patients with primary immune thrombocytopenia (ITP).
Primary ITP is a rare autoimmune disorder that causes a significant reduction in platelets, which are necessary for effective coagulation. Symptoms include the appearance of petechiae (clusters of red spots where capillaries below the skin have bled), excessive bruising, nose bleeds and bleeding of the gums from dental procedures. Women may also experience heavier and prolonged menstrual bleeding. The disease can cause fatigue and impact quality of life. In the most severe cases, ITP can become life-threatening.
Current therapies for ITP mostly aim to boost platelet counts (PCs) to either treat or prevent bleeds. The authors explain that while low PCs are a significant risk factor for these bleeding events in ITP, it is not a perfect correlation, as many other patient-specific and disease variables affect bleeding risk.
The paper also discusses clot risk. Individuals with ITP may also be at risk for venous thromboembolism (VTE), a scenario in which a clot forms in a deep vein, most often in the lower body. These clots have the potential to break free, travel through the bloodstream and into the lungs to cause a pulmonary embolism (PE). PEs are extremely dangerous and can result in disability and even death.
The authors cite several large population-based studies to suggest an increased risk for thromboembolic events, including comorbidities (the presence of other conditions), aging, and ITP therapies themselves which can be associated with an increased risks for clots.
ITP can also have major impacts on women’s health as pregnancy, childbirth, and birth control can propose management complications, as bleeding and clotting risks must be weighed depending on the scenario,
In summary, the authors lay out the clinical balancing act that must be performed to effectively manage the complex factors associated with bleeding vs. clotting risks in ITP patients. They also suggest that patients who are informed about ITP and risks can more “effectively collaborate with clinicians” to make decisions about their treatment. A strong case is therefore made for individualized care and enhanced patient education as part of a shared decision-making approach.
“Further research is needed to increase awareness and develop evidence-based, standardized guidelines, and valid tools to help physicians in decision-making and balancing the risk of bleeding against thrombosis in patients with ITP, explained the authors. “Profiling a patient's individual risk, using a tailored, patient-centric approach is essential. Comprehensive patient education should also form part of patient management to ensure patients are aware of symptoms of bleeding and thrombosis, and that they feel empowered to discuss their own treatment and care with their HCPs.”
Read the full review to learn much more about the authors conclusions, including the international studies underpinning them.
Citation
Lambert C, Maitland H, Ghanima W. Risk-based and individualized management of bleeding and thrombotic events in adults with primary immune thrombocytopenia (ITP). Eur J Haematol. 2024; 112(4): 504-515. doi:10.1111/ejh.14154
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