Risk factors of hospitalisation for thrombosis in adults with primary immune thrombocytopenia, including disease‐specific treatments: a French nationwide cohort study

Abstract

We aimed to assess the risk factors of venous thrombosis (VT) and arterial thrombosis (AT) in adults with primary immune thrombocytopenia (ITP), particularly in relation to treatments. The population comprised all incident primary ITP adults in France between 2009 and 2017 (FAITH cohort; NCT03429660) built in the national health database. Outcomes were the first hospitalisation for VT and AT. Multivariable Cox regression models included baseline risk factors, time-varying exposure to ITP drugs, splenectomy and to cardiovascular drugs. The cohort included 10 039 patients. A higher risk of hospitalisation for VT was observed with older age, history of VT, history of cancer, splenectomy [hazard ratio (HR) 3Á23, 95% confidence interval (CI) 2Á26-4Á61], exposure to corticosteroids (HR 3Á55, 95% CI 2Á74-4Á58), thrombopoietin-receptor agonists (TPO-RAs; HR 2Á28, 95% CI 1Á59-3Á26) and intravenous immunoglobulin (IVIg; HR 2Á10, 95% CI 1Á43-3Á06). A higher risk of hospitalisation for AT was observed with older age, male sex, a history of cardiovascular disease, splenectomy (HR 1Á50, 95% CI 1Á12-2Á03), exposure to IVIg (HR 1Á85, 95% CI 1Á36-2Á52) and TPO-RAs (HR 1Á64, 95% CI 1Á26-2Á13). Rituximab was not associated with an increased risk. These findings help to estimate the risk of thrombosis in adult patients with ITP and to select treatment.

Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms

“…The results of this study showed that the risk for venous thrombosis during hospitalization was observed in patients with a history of thrombosis, history of cancer, old age, and splenectomy. A higher risk of hospitalization for arterial thrombosis was observed in patients with older age, male sex, a history of cardiovascular disease, and splenectomy [147]. Another epidemiological report showed that smoking, hypertension, male gender, a history of thrombosis, and atrial fibrillation were significantly associated with the occurrence of thrombosis in ITP patients [148].…”

“…Other risk factors such as diabetes, hypertension, cardiovascular disease, old age, and obesity may contribute to the occurrence of thrombotic events alone or in association with additional risk factors related to ITP treatment or ITP as disease. A French nationwide cohort study published in 2021 [147] that included 10,039 patients assessed the risk factor for venous thrombosis and arterial thrombosis for patients with primary immune thrombocytopenic purpura. The results of this study showed that the risk for venous thrombosis during hospitalization was observed in patients with a history of thrombosis, history of cancer, old age, and splenectomy.…”

Is it the therapy or the disease? Exploring the link between treatment for immune thrombocytopenia and thrombosis

“…All listed agents were also associated with an increased risk of arterial thrombosis (AT), except for corticosteroids. Rituximab was not associated with an increased risk of either AT or VT 6 …”

“…Lafaurie et al seeks to address whether different therapies for ITP may contribute to thrombotic risk. 6 Indeed, this would be an important component of the risk-benefit discussion between clinicians and patients when selecting a treatment strategy. Distinguishing the thrombotic risk of ITP-directed therapies from disease-related factors is not an easy task.…”

“…All listed agents were also associated with an increased risk of arterial thrombosis (AT), except for corticosteroids. Rituximab was not associated with an increased risk of either AT or VT. 6 Fortunately, there now exists a growing list of therapies for ITP. First-line treatment for adult patients with ITP is relatively straightforward, using steroids +/À IVIG.…”