Cardiovascular and bleeding outcomes in a population‐based cohort of patients with chronic immune thrombocytopenia

Abstract

Background: Among patients with chronic immune thrombocytopenia (cITP), little is known regarding risk factors for cardiovascular and bleeding outcomes and how these events influence mortality. Objectives:We examined the rate of cardiovascular events and bleeding requiring a hospital contact according to platelet count levels, as well as the prognostic impact of these events on all-cause mortality in adult patients with cITP. Methods: We identified all cITP patients registered in the Nordic Country PatientRegistry for Romiplostim during 1996 to 2015. Absolute risks and hazard ratios across platelet count levels based on Cox regression analysis were computed, adjusting for age, sex, prevalent/incident cITP, smoking, and comorbidities. We also compared all-cause mortality rates in cITP patients with and without cardiovascular and bleeding events.Results: Among 3 584 cITP patients, 1-year risks were 1.9% for arterial cardiovascular events, 1.2% for venous thromboembolism, and 7.5% for bleeding. Rates of cardiovascular events were similar across platelet counts. Patients with platelet counts <50 × 10 9 /L had >2-fold higher rates of bleeding than patients with normal platelet counts. These associations were unchanged in time-varying analyses that considered changes in platelet counts during follow-up. Occurrences of cardiovascular and bleeding events were associated with 4-fold to 5-fold increases in 1-year mortality. Conclusions:Among patients with cITP, the 1-year risks of cardiovascular events were 1% to 2%, while nearly 8% experienced a bleeding event within 1 year.Cardiovascular events occurred across all platelet levels, while low platelet counts were associated with increased hazards of bleeding. Cardiovascular and bleeding events were strong prognostic factors for mortality. K E Y W O R D Sbleeding, chronic ITP, epidemiology, mortality, stroke, myocardial infarction, venous thromboembolism | 913 ADELBORG Et AL.

Long‐term outcomes of patients treated with rituximab as second‐line treatment for adult immune thrombocytopenia – Follow‐up of the RITP study

“…These data illustrate that ITP is a serious and occasionally a fatal disease. A recent study showed that in chronic ITP, a platelet count <25 × 10 9 /l was associated with a 7‐ and 4·5‐fold increase in the risk of haemorrhage requiring hospitalization at respectively one and five years, as compared to ITP patients with normal platelet counts 11 . It also showed that the risk of death was markedly higher among patients with a bleeding event requiring a hospital contact.…”

Primary Immune Thrombocytopenia: Novel Insights into Pathophysiology and Disease Management

“…Compared to ITP patients with normal platelet counts, those with a platelet count between 25 to 49 × 10 9 /L and <25 × 10 9 /L had 2.4 fold and 4.5 fold increased bleeding rates, respectively [51]. Furthermore, bleeding requiring a hospital contact within 1 year prior to ITP diagnosis was associated with a 3-fold increased rate of subsequent bleeding [51]. The use of non-steroidal anti-inflammatory drugs (NSAIDs) was found to be associated with any bleeding (OR 4.8, 95% CI 1.1-20.7) and anticoagulant drugs were associated with severe bleeding (OR 4.3, 95% CI 1.3-14.1) [57].…”

“…Compared to ITP patients with normal platelet counts, those with a platelet count between 25 to 49 × 10 9 /L and <25 × 10 9 /L had 2.4 fold and 4.5 fold increased bleeding rates, respectively [51]. Furthermore, bleeding requiring a hospital contact within 1 year prior to ITP diagnosis was associated with a 3-fold increased rate of subsequent bleeding [51].…”

“…Some patients can be asymptomatic at presentation and 30-40% of patients with chronic ITP do not have any bleeding symptom [50]. Bleeding risk is calculated as 8% per year in ITP patients [51].…”

A New Tool to Assess the Epidemiology of Immune Thrombocytopenia: The Nordic Country Patient Registry for Romiplostim

“…Overall, the NCPRR is a powerful tool to assess unsolved questions about ITP epidemiology like variations of incidences, rates of bleeding, thrombosis [9], infections and malignancies. Future pharmacoepidemiological studies are also eagerly awaited to assess in the real-world practice the exposure to ITP treatments as well as their efficacy and safety in the context of lack of comparative clinical trials in this rare disease.…”