Massive intrasplenic arterial thrombosis in a patient with chronic ITP during the development of an Evans syndrome. Issue 208 (December 2021)

• Record Type: Journal Article
• Authors: Diez-Feijóo, R.; Rodríguez-Sevilla, JJ; Colomo, L.; Papaleo, N.; Maiques, J.M.; Gimeno, E.; Andrade-Campos, M.; Abella, E.; Merchan, B.M.; Calvo, X.; Jimenez, C.; Román-Bravo, O.D.; Salar, A.; Sanchez-Gonzalez, B.
• Is Part Of: Thrombosis research. Issue 208(2021)
• Page Start: 226
• Page End: 229
• Publication Date: 2021-12
• Subjects: Thrombopoietin receptor agonist -- Eltrombopag -- Autoimmune haemolytic anemia -- Immune thrombocytopenia -- Thrombosis -- Evans syndrome; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.02.021
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Long-term safety and efficacy of eltrombopag in adults with persitent/chronic primary immune thrombocytopenia (ITP) evaluated in EXTEND study, showed a high response rate (80%) but, in the clinical safety study, it was observed that 6% of the patients presented venous and arterial thrombotic events. In addition, in the course of the disease, autoimmune hemolytic anemia (Evans syndrome, ES) may occur and could increase the risk of thrombosis. We report an interesting case of splenic rupture due to massive intrasplenic arterial thrombosis in the course of ES in a patient with chronic ITP treated with eltrombopag. The purpose of this case report is to highlight the potential increase in thrombotic risk that may involve the use of eltrombopag in hemolysis situations in patients with ITP. Highlights: Thrombotic major complications can occur in patients with ITP. Hemolysis and Evans syndrome may develop in the evolution of patients with ITP, which could increase the risk of such events. Safety of eltrombopag in specific situations should be further investigated. Individual thrombotic risk profile of patients treated with TPO-RA should be considered if any thromboprophylaxis is needed.