Recurrent venous and arterial thrombosis during anticoagulant treatment in a patient with immune thrombocytopenic purpura exacerbation

Abstract

Treatment of patients with immune thrombocytopenic purpura (ITP) associated with recurrent venous and arterial thrombosis can represent a major challenge. We present the rare case of a 56-year-old female who was first diagnosed with severe ITP at the age of 36. She required corticosteroid therapy and splenectomy in evolution. However, in the last three years she had several episodes of recurrent venous thromboembolism for which she required different anticoagulant therapies despite severe thrombocythemia. The patient also developed acute myocardial infarction treated by primary percutaneous coronary intervention that was complicated with acute intrastent thrombosis. Thus, maximal antiplatelet therapy was mandatory. For ITP, the patient received intravenous steroids, platelet transfusion as well as eltrombopag. Moreover, the patient also suffered from a haemorrhagic uterine fibroma that required surgery. Thus, a close multidisciplinary approach was needed for the successful treatment of this patient.