Idiopathic thrombocytopenic purpura in elderly patients: A study of 47 cases from a single reference center

Daou, Samira; Fédérici, Laure; Zimmer, Jacques; Maloisel, Frédéric; Serraj, Khalid; Andrès, Emmanuel

doi:10.1016/j.ejim.2007.07.006

Cited by 34 publications

(27 citation statements)

References 21 publications

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“…88 The decision to treat should be based on the individual patient's severity of bleeding, bleeding risk (eg, previous bleeding episodes, coincident risk factors for bleeding such as hypertension and age), activity level (eg, playing contact sports), likely side effects of treatment, and patient preferences. 85,[89][90][91][92][93][94][95][96][97][98][99][100][101] Women with chronic ITP may have heavy menstrual periods that interfere with their daily activities or result in iron deficiency anemia, both findings that may influence the decision to treat. There is limited evidence on which to base treatment recommendations on a specific platelet count or age for all patients.…”

Section: Question: When Is Treatment Indicated For Newly Diagnosed Itp?mentioning

confidence: 99%

“…The outcomes from ITP do appear to be improving; the original ASH guideline reported a mortality rate for patients with newly diagnosed ITP between 1928-1989 of 2.1%, compared with a mortality rate of 0.8% in patients with newly diagnosed ITP between 1973-2004 (including papers published after the last ASH review). 85,[89][90][91][92][93][94][95][96][97][99][100][101] Care must be taken in interpreting the estimates of the rates of death as these papers are very heterogeneous. In contrast, mortality for patients with chronic ITP has not improved to the same extent, with a mortality rate of 5.4% (25/465 patients) in the original ASH guideline compared with mortality rates of 6.6% (6/91 patients) in more recently reported studies.…”

Section: Question: When Is Treatment Indicated For Newly Diagnosed Itp?mentioning

confidence: 99%

“…A large number of papers present data relevant to first-line treatment of ITP. 87,89,91,96,97,[99][100][101][102][103][104][105][106][107][108][109] If treatment is required for ITP, it should be tailored to the individual patient, taking into account the presence and severity of bleeding, the rapidity of desired platelet count rise, and possible side effects. We recommend longer courses of corticosteroids (eg, prednisone 1 mg/kg orally for 21 days then tapered off) over either shorter courses of corticosteroids (eg, dexamethasone 40 mg orally for 4 days) or IVIg because longer courses of corticosteroids are associated with a longer time to the loss of response in the only study that has compared short-course therapy (IVIg or intravenous corticosteroids on days 1-3 followed by placebo on days 4-21) with long-course therapy (IVIg or intravenous corticosteroids on days 1-3 followed by oral corticosteroid therapy on days 4-21).…”

Section: Question: What Is Suitable First-line Treatment For Newly DImentioning

confidence: 99%

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The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

Neunert

Lim

Crowther

et al. 2011

Blood

1,648

1,783

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Immune thrombocytopenia (ITP) is commonly encountered in clinical practice. In 1996 the American Society of Hematology published a landmark guidance paper designed to assist clinicians in the management of this disorder. Since 1996 there have been numerous advances in the management of both adult and pediatric ITP. These changes mandated an update in the guidelines. This guideline uses a rigorous, evidence-based approach to the location, interpretation, and presentation of the available evidence. We have endeavored to identify, abstract, and present all available methodologically rigorous data informing the treatment of ITP. We provide evidence-based treatment recommendations using the GRADE system in those areas in which such evidence exists. We do not provide evidence in those areas in which evidence is lacking, or is of lower quality-interested readers are referred to a number of recent, consensus-based recommendations for expert opinion in these clinical areas. Our review identified the need for additional studies in many key areas of the therapy of ITP such as comparative studies of "front-line" therapy for ITP, the management of serious bleeding in patients with ITP, and studies that will provide guidance about which therapy should be used as salvage therapy for patients after failure of a first-line intervention. (Blood. 2011;117(16):4190-4207)

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Section: Question: When Is Treatment Indicated For Newly Diagnosed Itp?mentioning

confidence: 99%

Section: Question: When Is Treatment Indicated For Newly Diagnosed Itp?mentioning

confidence: 99%

Section: Question: What Is Suitable First-line Treatment For Newly DImentioning

confidence: 99%

See 1 more Smart Citation

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

Neunert

Lim

Crowther

et al. 2011

Blood

1,648

1,783

View full text Add to dashboard Cite

show abstract

“…One Danish and one Italian study found no association between age and bleeding (Frederiksen & Schmidt, 1999; ), but other studies suggested that older ITP patients with a platelet count <30 9 10 9 /l are at greater risk of bleeding (Cortelazzo et al, 1991;Bourgeois et al, 2003;Bizzoni et al, 2006;Daou et al, 2008). A recent French nationwide ITP study showed a linear correlation between age and both risk of gastrointestinal bleeding and cerebral haemorrhage (Moulis et al, 2014).…”

Section: How Is Itp Diagnosed In the Elderly?mentioning

confidence: 99%

“…Corticosteroids are as effective in older adults as in younger patients (Daou et al, 2008;Michel et al, 2011), but their side effects are often underestimated in the ITP setting (Moulis et al, 2015). Gastritis, corticosteroid-induced diabetes, psychosis and infections are among the most frequent adverse events (Cortelazzo et al, 1991;Daou et al, 2008;Tamez-Perez et al, 2015).…”

Section: Nomentioning

confidence: 99%

How we manage immune thrombocytopenia in the elderly

2016

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SummaryWith prolonged life expectancy, immune thrombocytopenia (ITP) is frequent in elderly people. In this setting, ITP diagnosis is challenging because of the concern about an underlying myelodysplastic syndrome. Studies of older adults are lacking, and recommendations for treatment are based mainly on expert opinion. The therapeutic strategy differs from that for younger patients and must take into account the greater risk of bleeding and thrombosis, presence of comorbidities, possible impaired cognitive performance or poor life expectancy and concomitant medications, such as anticoagulant and antiplatelet therapy. Steroids and intravenous immunoglobulin (IVIg) therapy remain the first-line treatments in elderly patients, but prolonged treatment with steroids should be avoided and IVIg treatment may lead to renal failure. Splenectomy is less effective than in young patients and risk of thrombosis is increased. Severe co-morbidities can also contraindicate surgery. Therefore, other second-line treatments are frequently preferred. Danazol and dapsone can be an option for the less severe ITP form. Rituximab is a good option except in patients with a history of infection or with hypogammaglobulinaemia. Thrombopoietin agonists are attractive, especially for patients with severe comorbidities or with limited life expectancy but the risk of thrombosis is a concern.

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Characteristics and outcome of immune thrombocytopenia in elderly: Results from a single center case‐controlled study

et al. 2011

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The management of ITP in elderly raises several questions that have not been fully addressed in the literature. To assess the impact of ITP in elderly, a case-control study was performed. The main characteristics at onset and the outcome of ITP in 55 patients aged of 70 years and above (cases) were compared with those of 97 younger adults (controls) seen at the same tertiary referral institution. The mean age at diagnosis was respectively 77.8 ± 6.1 years (cases) and 40.3 ± 14.9 years (controls). While the median platelet count at time of diagnosis was not significantly different in cases and controls (6310 9 /L, range: 2-26 versus 12310 9 /L: 5-21.5), bleeding symptoms were more frequent in cases (82%) than in the controls (68%, p50.07), and the median bleeding score was significantly higher in elderly (p50.001). The rate of treatmentrelated adverse events was more than twofold higher in elderly patients and the mean cumulative duration of hospital stay for ITP during the follow-up period was much longer when compared to the controls (p<0.0001). Three ITP-related deaths (5.4%) including 1 from intracranial hemorrhage occurred in the cases but none in the controls. In conclusion, this study confirms that at equivalent platelet count, ITP has a greater impact in elderly. Am. J. Hematol. 86:980-984, 2011. V

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Idiopathic thrombocytopenic purpura in elderly patients: A study of 47 cases from a single reference center

Cited by 34 publications

References 21 publications

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

How we manage immune thrombocytopenia in the elderly

Characteristics and outcome of immune thrombocytopenia in elderly: Results from a single center case‐controlled study

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