Eltrombopag-Induced Thrombocytosis and Thrombosis in Patients With Antiphospholipid Syndrome and Immune Thrombocytopenic Purpura

Abstract

Antiphospholipid syndrome (APS) may be either as a primary or in association with an underlying systemic autoimmune etiology (36.2%), particularly systemic lupus erythematosus (SLE). Thrombocytopenia is infrequently observed in APS patients, with an occurrence of 22% to 42% with the frequency of thrombocytopenia, higher in APS and SLE combination than in primary APS. There have been some controversial reports regarding the treatment of APS syndrome with thrombocytopenia with TPO agonists. We like to report a case with APS syndrome with severe thrombocytopenia treated with TPO-RA and developed severe thrombocytosis and thrombosis. Our case represented the first case of TPO-RA in treating APS syndrome developed severe thrombocytosis and our case also concurred that use of TPO-RA agents should be strongly discouraged in APS until larger studies clarify the safety of TPO-RA agents in APS.

An obvious antinomy, superior sagittal sinus thrombosis in a patient with immune thrombocytopenia: Case report and a review of literatures

“…[14–17] Drugs may cause arterial vasospasm, increase plasma viscosity and promote thrombosis by inducing platelets and endothelial cell activation, increas ing the level of coagulation factors and reducing the level of antithrombotic factors (Table 1 presents the thrombogenic mechanism of drugs combined with this patient’s medication). [18–28]…”

“…[14][15][16][17] Drugs may cause arterial vasospasm, increase plasma viscosity and promote thrombosis by inducing platelets and endothelial cell activation, increas ing the level of coagulation factors and reducing the level of antithrombotic factors (Table 1 presents the thrombogenic mechanism of drugs combined with this patient's medication). [18][19][20][21][22][23][24][25][26][27][28] Splenectomy may also increase the risk of thrombosis. When splenectomy is done, damaged cells and microsomes with procoagulant effect constantly persist in the blood, resulting in the transformation of vascular homeostasis to enhanced coagulation.…”

“…[23,24] TPO-RA TPO-RA induces the proliferation and differentiation of megakaryocyte precursor cells in bone marrow, increasing the peripheral platelet count. [25][26][27]…”

Treatment of Acute Ischaemic Stroke and Concomitant Multiple Arterial Splanchnic Thromboses in a Patient with Immune Thrombocytopenia on Thrombopoietin Agonist: A Case Report

“…Of these, 1.9% were considered SAE, of which one patient died from cerebral venous thrombosis. Several reports of thrombotic complications during eltrombopag treatment were reported, in the context either of ITP [ 40 , 41 , 42 , 43 , 44 , 45 ] or of secondary thrombocytopenia [ 46 , 47 , 48 , 49 , 50 , 51 ]. However, our patient represents the only case published to date suffering multiple concurrent thrombotic events.…”