Cost of Bleeding-related Episodes in Adult Patients With Primary Immune Thrombocytopenia: A Population-based Retrospective Cohort Study of Administrative Claims Data for Commercial Payers in the United States

Lin, Joseph P.; Zhang, Xinke; Li, Xiaoyan; Chandler, David; Altomare, Ivy; Wasser, Jeffrey S.; Cetin, Karynsa

doi:10.1016/j.clinthera.2017.01.023

Cited by 10 publications

(3 citation statements)

References 27 publications

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“…Major bleeds, while less common, can result in death or significant morbidity, 1 including disability, reduced health-related quality of life, and high health-care costs. 2 Major bleeds in older adults carry an especially poor prognosis, with a 5-year risk of death approaching 50%. 1 Treatment of major bleeds requires a rapid, coordinated, multidisciplinary approach that includes emergency department (ED) physicians, hematologists, other specialists, and transfusion medicine staff.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with ITP are often asymptomatic, or present with minor mucocutaneous bleeding. Major bleeds, while less common, can result in death or significant morbidity, 1 including disability, reduced health‐related quality of life, and high health‐care costs 2 . Major bleeds in older adults carry an especially poor prognosis, with a 5‐year risk of death approaching 50% 1 …”

Section: Introductionmentioning

confidence: 99%

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Management of major bleeds in patients with immune thrombocytopenia

Mithoowani

Cervi

Shah

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: A standard approach to the recognition and management of major bleeding in immune thrombocytopenia (ITP) is lacking.Methods: Retrospective cohort study of ITP patients presenting to the emergency department (ED) with severe thrombocytopenia (platelet count <20 × 10 9 /L) and bleeding in four academic hospitals from 2008 to 2016. We defined a major ITP bleed as a bleed at a critical site or causing hemodynamic instability. Results:We identified 112 ITP patients (n = 141 visits) who presented to the ED with platelets <20 × 10 9 /L and bleeding. Twenty-nine patients (26%) had 32 ED visits with major bleeds. Risk factors for major bleeds were older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.06), male sex (OR 3.25, 95% CI 1.22-9.32), and more prior ITP therapies (OR 1.42, 95% CI 1.10-1.87). Acute treatment of major bleeds required a median of three treatments (interquartile range [IQR] 2 -4), which included intravenous immune globulin (91% of visits), corticosteroids (78% of visits), and platelet transfusions (75% of visits). Three patients (10%) died, nine (31%) developed recurrent bleeds, one (3%) developed arterial thrombosis, and one (3%) had permanent neurological disability. Six patients presented with minor bleeding and subsequently developed a major bleed after a median of 2 days (IQR 1-3). All six patients had oral purpura and four of six had gross hematuria preceding the major bleed. Conclusions:Major ITP bleeds are associated with significant morbidity and mortality. Oral purpura and hematuria often preceded major bleeds. Further research is needed to refine the definition of a major ITP bleed and develop evidence-based treatment strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of major bleeds in patients with immune thrombocytopenia

Mithoowani

Cervi

Shah

et al. 2020

Journal of Thrombosis and Haemostasis

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“…The occurrence of ITP results from the generation of anti-platelet autoantibodies against platelet membrane glycoproteins finally leading to the destruction of platelets in the reticuloendothelial system, especially in the spleen (Zhang et al, 2015). ITP patients have an increased risk of bruising, cutaneous bleeding, and infrequently serious bleeding including intracranial hemorrhage (Lin et al, 2017). In addition, the quality of life of ITP patients is affected as a result of the physical and psychological symptoms, discomfort, fear, reduced social activity, and reduced ability to work (López et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Elucidation of the Mechanisms and Molecular Targets of Yiqi Shexue Formula for Treatment of Primary Immune Thrombocytopenia Based on Network Pharmacology

Jiang

Liu²,

Zhu

et al. 2019

Front. Pharmacol.

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Yiqi Shexue formula (YQSX) is traditionally used to treat primary immune thrombocytopenia (ITP) in clinical practice of traditional Chinese medicine. However, its mechanisms of action and molecular targets for treatment of ITP are not clear. The active compounds of YQSX were collected and their targets were identified. ITP-related targets were obtained by analyzing the differential expressed genes between ITP patients and healthy individuals. Protein–protein interaction (PPI) data were then obtained and PPI networks of YQSX putative targets and ITP-related targets were visualized and merged to identify the candidate targets for YQSX against ITP. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis were carried out. The gene-pathway network was constructed to screen the key target genes. In total, 177 active compounds and 251 targets of YQSX were identified. Two hundred and thirty differential expressed genes with an P value < 0.005 and |log2(fold change)| > 1 were identified between ITP patient and control groups. One hundred and eighty-three target genes associated with ITP were finally identified. The functional annotations of target genes were found to be related to transcription, cytosol, protein binding, and so on. Twenty-four pathways including cell cycle, estrogen signaling pathway, and MAPK signaling pathway were significantly enriched. MDM2 was the core gene and other several genes including TP53, MAPK1, CDKN1A, MYC, and DDX5 were the key gens in the gene-pathway network of YQSX for treatment of ITP. The results indicated that YQSX’s effects against ITP may relate to regulation of immunological function through the specific biological processes and the related pathways. This study demonstrates the application of network pharmacology in evaluating mechanisms of action and molecular targets of complex herbal formulations.

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Estimating the cost of BREs in ITP in the US

2017

PharmacoEcon Outcomes News

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Cost of Bleeding-related Episodes in Adult Patients With Primary Immune Thrombocytopenia: A Population-based Retrospective Cohort Study of Administrative Claims Data for Commercial Payers in the United States

Cited by 10 publications

References 27 publications

Management of major bleeds in patients with immune thrombocytopenia

Management of major bleeds in patients with immune thrombocytopenia

Elucidation of the Mechanisms and Molecular Targets of Yiqi Shexue Formula for Treatment of Primary Immune Thrombocytopenia Based on Network Pharmacology

Estimating the cost of BREs in ITP in the US

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