Cerebral venous sinus thrombosis in immune thrombocytopenia patients treated with thrombopoietin receptor agonist: Case reports and literature review

Teekaput, Chutithep; Nadsasarn, Angkana; Tanprawate, Surat; Soontornpun, Atiwat; Thiankhaw, Kitti; Wantaneeyawong, Chayasak; Teekaput, Kanokkarn; Chai‐Adisaksopha, Chatree

doi:10.1016/j.amsu.2022.104116

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…Therefore, the occurrence of cerebral venous thrombosis in children is likely to be associated with eltrombopag and should be considered during clinical application. For adults, previous studies have reported conditions such as arterial thrombosis, cerebral venous sinus thrombosis, pulmonary embolism, deep vein thrombosis, and cerebral venous thrombosis 23,28–31 . Our results similarly showed that multisite venous thrombosis in patients aged 18–64 and ≥ 65 years requires additional attention.…”

Section: Discussionsupporting

confidence: 83%

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Safety Profile of Eltrombopag in Different Age Groups: An Analysis of Real‐World Pharmacovigilance and Randomized Clinical Trials

et al. 2023

Clin Pharma and Therapeutics

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Eltrombopag is clinically approved for use in immune thrombocytopenia (ITP), chronic hepatitis C-related thrombocytopenia, and aplastic anemia and suitable for children; however, data on its overall safety profile are scarce. This study aimed to explore the clinical features of adverse drug events (ADEs) associated with eltrombopag in different age groups using individual case safety reports (ICSRs) from the World Health Organization database VigiBase and the US Food and Drug Administration Adverse Event Reporting System database from 2008 to 2022 in combination with a meta-analysis of data from randomized clinical trials in the literature from inception to July 28, 2022. We conducted disproportionality analyses by grouping patients into the following age groups: 0-17 (0-23 months, 2-11 years, and 12-17 years), 18-64, and ≥ 65 years. The ADEs about hepatobiliary disorders, thrombosis, skin and subcutaneous tissue disorders, infections, and so on were observed more differently in each age group. Meta-analysis results showed differences in the four system organ classes between adults and children with ITP: infections and infestations, general disorders and administration site conditions, skin and subcutaneous tissue disorders, and investigations. The adverse drug reactions in the latest version of instructions were searched in the databases to analyze their postmarketing safety signal strength. We observed signals of elevated alanine aminotransferase, aspartate aminotransferase, and blood bilirubin levels in all age groups. For children, urinary tract infection and back pain showed signals. Due to the inherent limitations of pharmacovigilance studies, more experiments are needed to assess the risks of eltrombopag in different ages.

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Section: Discussionsupporting

confidence: 83%

“…For adults, previous studies have reported conditions such as arterial thrombosis, cerebral venous sinus thrombosis, pulmonary embolism, deep vein thrombosis, and cerebral venous thrombosis. 23,[28][29][30][31] Our results similarly showed that multisite venous thrombosis in patients aged 18-64 and ≥ 65 years requires…”

Section: Articlesupporting

confidence: 77%

Safety Profile of Eltrombopag in Different Age Groups: An Analysis of Real‐World Pharmacovigilance and Randomized Clinical Trials

et al. 2023

Clin Pharma and Therapeutics

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“…13 In cases of CVST patient usually presents with headache of various severity, nausea, vomiting, visual disturbances and in most cases also the optic disc changes have been seen. 14 The diagnosis of ITP is considered after exclusion of all other possible secondary causes whereas the diagnosis of CVST is straightforward and radiological imaging mostly MRV and MR imaging of the brain is the standard modality of diagnosis. Regarding the management of ITP the primary goal is to maintain adequate level of platelets and control the bleeding tendency.…”

Section: Discussionmentioning

confidence: 99%

“…Prednisolone, dexamethasone, and methylprednisolone is considered the baseline management whereas in case of an emergency setting, intravenous immunoglobulin and anti‐D plays vital role in acutely raising the platelets level and prevent patient deterioration 15 Furthermore American Society of Hematology recommends thrombopoetion receptor agonist(TPO‐RA) either romiplostim or eltrombopag as the second‐line therapy for people suffering from ITP who are corticosteroid‐dependent or resistant to corticosteroids for at least 3 months 15 . In case of CVST systemic anticoagulation with low molecular weight heparin and unfractionated heparin is considered standard modality of management which can bring about good prognosis in symptomatic improvement and drastic recanalization., 16,17 In recent decade there has been rise in the cases of venous thrombotic events such as CVST but very less number of reports have talked about CVST in diagnosed cases of ITP 14,18,19,20 . In majority of such cases where CVST and ITP coexist pharmacological treatment has been prioritized but endovascular intervention such as mechanical thrombectomy in selected patients can also bring about fruitful prognosis.…”

Section: Discussionmentioning

confidence: 99%

Cerebral venous sinus thrombosis in patient of immune thrombocytopenic purpura managed with mechanical thrombectomy: An anecdotal endovascular experience from lower middle income country

Ghimire,

Shrestha,

Shrestha

et al. 2024

Clinical Case Reports

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“… 39 Additionally, various cases of TPORD-induced TEE have been reported. 40 – 42 There are several potential prothrombotic mechanisms by which TPORDs contribute to thrombosis. First, it may be related to the ability of TPORDs to significantly increase platelet counts in a short period of time.…”

Section: Discussmentioning

confidence: 99%

Association of thrombopoietin-related drugs with thromboembolic events: Mendelian randomization and a real-world study

Liang,

Chen,

Zhang

2024

Therapeutic Advances in Drug Safety

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Background: Studies have shown conflicting results when using thrombopoietin-related drugs (TPORD) for thromboembolic events (TEEs). Our study aimed to explore the correlation between TPORDs and TEEs. Method: Drug-targeted Mendelian randomization (MR) and multivariate MR (MVMR) analysis were used to explore the causal relationship between TPORDs and TEEs such as venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI) and ischemic stroke (STR). At the same time, a real-world study was conducted by extracting adverse events (AEs) from the FDA Adverse Event Reporting System database included in AERSMine to further validate our findings. Outcome: In drug-target MR, TPORDs were associated with VTE (OR = 1.193, 95% confidence interval (CI): 1.001–1.423, p = 0.049], DVT (OR = 1.321, 95% CI: 1.027–1.700, p = 0.030), MI (OR = 1.216, 95% CI: 1.010–1.464, p = 0.039), STR (OR = 1.224, 95% CI: 1.021–1.468, p = 0.029). VTE/DVT/STR remained stable in MVMR (VTE: OR = 1.3, 95% CI: 1.187–1.422, p < 0.001; DVT: OR = 1.465,95% CI:1.285–1.671, p < 0.001; STR: OR = 1.119, 95% CI: 1.018–1.229, p = 0.019) and real-world studies [lower bound of proportional reporting ratio (ROR) greater than 1]. The significance of myocardial infarction disappeared in MVMR (OR = 0.996, 95% CI: 0.894–1.109, p = 0.942) and in real-world studies (lower ROR lower than 1). There was no evidence of a causal relationship between TPORD and PE (OR = 1.244, 95% CI: 0.969-1.597, p = 0.087), but it generated a signal from a real-world study (lower bound of ROR greater than 1). Conclusion: This study suggests that TPORDs may be associated with an increased risk of TEEs, particularly AEs leading to VTE/DVT/STR. In addition, the relationship between TPORDs and PE/MI is debatable and requires more research.

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Cerebral venous sinus thrombosis in immune thrombocytopenia patients treated with thrombopoietin receptor agonist: Case reports and literature review

Cited by 8 publications

References 15 publications

Safety Profile of Eltrombopag in Different Age Groups: An Analysis of Real‐World Pharmacovigilance and Randomized Clinical Trials

Safety Profile of Eltrombopag in Different Age Groups: An Analysis of Real‐World Pharmacovigilance and Randomized Clinical Trials

Cerebral venous sinus thrombosis in patient of immune thrombocytopenic purpura managed with mechanical thrombectomy: An anecdotal endovascular experience from lower middle income country

Association of thrombopoietin-related drugs with thromboembolic events: Mendelian randomization and a real-world study

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