Complete splenic embolization in the treatment of immune thrombocytopenic purpura

Lagares, Martinez; Fuertes, Fernandez; Cabrero, Hernandez; Benitez, Bosch; Miguel, Gonzalez San; [], Martin; MartÍn, Tapia; Montero, M.; Llorente, Viejo; Perez, Givica; Cremades, Díaz

doi:10.1046/j.1365-2141.1998.01120.x

Cited by 4 publications

(12 citation statements)

References 6 publications

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“…Because a small accessory spleen can almost certainly cause relapse, leaving a residual quantity of spleen (as in partial splenic embolization) can cause any long-term remission to fail. On the basis of this consideration, Martinez Lagares et al 95 prospectively performed total splenic embolization in 13 patients, of whom 5 were dependent on high doses of corticosteroids to maintain a safe platelet count (>30 × 10 9 /L) and 8 were corticosteroid resistant with a sustained low platelet count (<30 × 10 9 /L). Complete embolization was achieved in 12 patients, and a partial embolization was achieved in 1 patient with an aberrant splenic artery.…”

Section: Pattern Of Uptakementioning

confidence: 99%

Management of Immune Thrombocytopenic Purpura in Adults

Stasi

Provan

2004

Mayo Clinic Proceedings

177

185

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Primary immune thrombocytopenic purpura (ITP), also referred to as idiopathic thrombocytopenic purpura, is an organ-specific autoimmune disorder in which antibody-coated or immune complex-coated platelets are destroyed prematurely by the reticuloendothelial system, resulting in peripheral blood thrombocytopenia. The disease is heterogeneous with regard to its severity and clinical course and is unpredictable in its response to therapy. Although the basic underlying pathophysiology of ITP has been known for more than 50 years, current treatment guidelines are based on expert opinion rather than on evidence because of a lack of high-quality clinical trials and research. The only patients for whom treatment is clearly required are those with severe bleeding and/or extremely low platelet counts (< 10 x 10(9)/L). Treatment of patients with ITP refractory to corticosteroids and splenectomy requires careful evaluation of disease severity, patient characteristics related to risk of bleeding, and adverse effects associated with treatment. Clinical trials with numerous new agents are under way, which we hope will add more effective and targeted strategies to our therapeutic armamentarium. We describe a logical and structured approach to the clinical management of ITP in adults, based on a literature review and our personal experience.

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Section: Pattern Of Uptakementioning

confidence: 99%

Management of Immune Thrombocytopenic Purpura in Adults

Stasi

Provan

2004

Mayo Clinic Proceedings

177

185

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“…Others reported similar overall response rates at 1 year. 34,[36][37][38][39] Significant differences among studies were noted in the definition of complete, partial and no response. These differences were observed in studies prior to and after the publication of consensus criteria and definitions to standardize the terminology and outcome criteria in ITP of adults and children.…”

Section: Discussionmentioning

confidence: 99%

“…After exclusion of review publications and duplicate reports, 24 reports were included in the final analysis. Nine studies included five or more patients and these were used in the analysis of effectiveness (228 patients), 7,13,[34][35][36][37][38][39][40] and 15 studies were included in the safety analysis (151 patients). 13,16,22,31,[33][34][35][37][38][39][40][41][42][43][44]…”

Section: R E Su Ltsmentioning

confidence: 99%

“…Three studies utilized post-procedure computed tomography (CT) scans, conducted between 1 and 4 weeks after SE, to evaluate effectiveness and ascertain the size of embolized splenic tissue. 13,37,38 One study employed post-procedure angiography, 40 while three studies estimated the size of embolized splenic tissue through visual inspection during the procedure. 7,34,35 However, two studies did not report measures used to assess the degree of SE.…”

Section: Assessment Of the Degree Of Sementioning

confidence: 99%

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The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

Egbaria,

Touma,

Cohen‐Abadi

et al. 2024

Br J Haematol

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SummaryThe effectiveness of splenic embolization (SE) in treating refractory immune thrombocytopenia (ITP) remains uncertain. A systematic literature review was undertaken to assess the effectiveness and safety of SE in treating both paediatric and adult patients with ITP. We conducted an extensive search employing predefined criteria. We extracted platelet counts at baseline and at multiple intervals following SE, along with details of the proportion of embolized spleen parenchyma and the proportion of patients exhibiting complete or partial platelet count responses. We identified nine eligible reports for the analysis of effectiveness (228 patients) and 15 reports for the safety analysis (151 patients). Pooled estimates of complete response (platelet count >100 × 109/L) and overall response (platelet count >30 × 109/L) were 50.1% (95% CI: 38–62.3) and 74.4% (95% CI: 64.9–83.9) respectively. Most studies applied an embolization of at least 60% of the spleen parenchyma. Nearly all the patients suffered from mild adverse events (AEs), 1.3% suffered from serious AEs and one patient died (0.7%). In conclusion, SE resulted in an overall response rate in 74.4% of patients with ITP. However, this finding derives from uncontrolled studies of low to moderate quality.

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“…Il est cependant important de souligner que le risque d'infection grave à germes encapsulés, et en particulier à pneumocoque, reste important et que la prévention de ces infections par la vaccination, l'antibioprophylaxie dont la durée reste discutée et surtout l'éducation du patient et de son entourage restent fondamentales. Des alternatives à la splénectomie ont été proposées il y a quelques années pour les patients les plus fragiles telles que l'irradiation splénique ou l'embolisation splénique [21][22][23]. Aucune donnée récente ne permet de confirmer le bien fondé de ces options thérapeutiques.…”

Section: Splénectomieunclassified

Traitement du purpura thrombopénique auto-immun de l’adulte

Godeau

Bierling

2008

La Presse Médicale

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Complete splenic embolization in the treatment of immune thrombocytopenic purpura

Cited by 4 publications

References 6 publications

Management of Immune Thrombocytopenic Purpura in Adults

Management of Immune Thrombocytopenic Purpura in Adults

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

Traitement du purpura thrombopénique auto-immun de l’adulte

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