Would you offer TPO-RAs to a steroid-refractory chronic ITP patient with history of stroke?
Is the thrombotic risk associated with TPO-RAs only relevant to VTE or does it also apply to arterial thromboses and stroke? Can the risk be mitigated with appropriate targeting of platelet count?
What platelet count would you target to allow for stroke-directed anti-platelet or anticoagulation therapy?
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Would you offer TPO-RAs for chronic ITP in a patient with prior stroke?
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Hematology · BIDMC
Answered on · Updated on
Yes, if needed, though with a bit of trepidation, and it probably wouldn't be my first choice. Second-line chronic ITP treatment can include TPO-RA, rituximab, or splenectomy, and no one treatment is clearly better than the others (Neunert et al., PMID 31794604). Both splenectomy and TPO-RAs have in...
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