Treatment of Critical Bleeds in Patients With Immune Thrombocytopenia: A Systematic Review
Recommended Citation
Chowdhury SR, Sirotich E, Guyatt G, Gill D, Modi D, Venier LM, Mahamad S, Chowdhury MR, Eisa K, Beck CE, Breakey VR, de Wit K, Porter S, Webert KE, Cuker A, O'Connor C, DiRaimo JM, Yan JW, Manski C, Kelton JG, Kang M, Strachan G, Hassan Z, Pruitt B, Pai M, Grace RF, Paynter D, Charness J, Cooper N, Fein S, Agarwal A, Nazaryan H, Siddiqui I, Leong R, Pallapothu S, Wen A, Xu E, Liu B, Shafiee A, Rathod P, Kwon H, Dookie J, Zeraatkar D, Thabane L, Couban R, and Arnold DM. Treatment of Critical Bleeds in Patients With Immune Thrombocytopenia: A Systematic Review. Eur J Haematol 2024.
Document Type
Article
Publication Date
3-1-2025
Publication Title
European journal of haematology
Abstract
OBJECTIVES: Evidence-based protocols for managing bleeding emergencies in patients with immune thrombocytopenia (ITP) are lacking. We conducted a systematic review of treatments for critical bleeding in patients with ITP.
METHODS: We included all study designs and extracted data in aggregate or individually for patients who received one or more interventions and for whom any of the following outcomes were reported: platelet count response, bleeding, disability, or death.
RESULTS: We identified 49 eligible studies reporting 112 critical bleed patients with ITP, including 66 children (median age, 10 years), 36 adults (median age, 41.5 years), and 10 patients with unreported age. Patients received corticosteroids (n = 67), IVIG (n = 49), platelet transfusions (n = 41), TPO-RAs (n = 17), and splenectomy (n = 28) either alone or in combination. Studies reported 29 different treatment combinations, the 5 most common were corticosteroids, platelet transfusion and splenectomy (n = 13), corticosteroids and IVIG (n = 13), or splenectomy alone (n = 13); IVIG alone (n = 11); and corticosteroids, IVIG and TPO-RA (n = 8). Mortality among patients with critical bleeds in ITP was 30.6% for adults and 19.7% for children.
CONCLUSIONS: The effects of individual treatments on patient outcomes were uncertain due to very low-quality evidence. There is a need for a standardized approach to the treatment of ITP critical bleeds.
SYSTEMATIC REVIEW REGISTRATION: CRD42020161206.
Medical Subject Headings
Humans; Purpura, Thrombocytopenic, Idiopathic; Hemorrhage; Splenectomy; Treatment Outcome; Immunoglobulins, Intravenous; Child; Adult; Platelet Transfusion; Adrenal Cortex Hormones; Disease Management; Combined Modality Therapy
PubMed ID
39552264
ePublication
ePub ahead of print
Volume
114
Issue
3
First Page
458
Last Page
468
