Risk of thrombotic events in immune thrombocytopenia patients treated with thrombopoietic agents: a systematic review and meta-analysis.
Risk of thrombotic events in immune thrombocytopenia patients treated with thrombopoietic agents: a systematic review and meta-analysis.
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DOI：
10.1186/s12959-023-00509-z
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发表时间：
2023-06-23
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
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免疫性血小板减少症（ITP）是一种以血小板计数低为特征的众所周知的出血性疾病，已被证明与血栓形成的风险相关。血小板生成剂（TA）被广泛用作ITP的二线治疗，有效降低出血风险。然而，血栓形成，一个潜在的不利影响的TA，提出了临床挑战。在MEDLINE（PubMed）、Embase和科克伦图书馆数据库中系统检索相关研究，包括单组试验和随机对照试验（RCT），无语言限制。共纳入了17项RCT（包括2，105例患者）和29项单臂试验（包括3，227例患者）。在单组荟萃分析中，接受TA治疗的ITP患者的总体血栓形成事件汇总率为2.2%（95% CI 1.0%-3.7%）。在随机对照试验中，血栓形成的发生率较高，（33/1425 vs. 4/680），总体、动脉和静脉血栓形成事件的风险比（RR）更高（1.73，95% CI [0.88，3.39]，P = 0.113; RR 1.98，95% CI [0.80，4.92]，P = 0.141; RR 1.06，95%CI [0.46，2.41]，P = 0.895），但差异无统计学意义。亚组分析表明，与艾曲泊帕、avatrombopag、romiplostim和rhTPO相比，het是唯一没有增加血栓形成风险的TA（发生率0.3%，95% CI [0.0 - 1.5%]; RR 0.76，95% CI [0.03，18.41]，P = 0.864）。亚组分析还显示，高龄ITP患者（3.7% vs. 1.3%，P = 0.132）或有血栓形成病史的患者（3.0% vs. 1.4%，P = 0.257）以及长期接受TA治疗的患者（4.7% vs. 0.1%，P < 0.001）血栓形成的风险增加。我们的研究结果表明，接受TA治疗的ITP患者总体、动脉和静脉血栓形成事件的风险无显著性升高。此外，het是避免血栓形成倾向的推荐TA。接受长期TA的患者以及老年ITP患者或有血栓形成史的患者面临血栓形成风险增加。一般而言，临床医生应考虑潜在的血栓形成风险，解决潜在的风险因素，并确保在治疗患有TA的ITP患者时进行持续监测和随访。在线版本包含补充材料，可通过10.1186/s12959-023-00509-z获得。
Immune thrombocytopenia (ITP), which is a well-known hemorrhagic disorder characterized by low platelet counts, has been shown to be associated with the risk of thrombosis. Thrombopoietic agents (TAs) are extensively used as second-line treatments for ITP, effectively reducing the risk of hemorrhage. However, thrombosis, a potential adverse effect of TAs, raises clinical challenges. The MEDLINE(PubMed), Embase, and the Cochrane Library databases were systematically searched for relevant studies, including both single-arm trials and randomized controlled trials (RCTs), without language restrictions. A total of 17 RCTs comprising 2,105 patients and 29 single-arm trials comprising 3,227 patients were included. In the single-arm meta-analysis, the pooled rate of overall thrombotic events in ITP patients receiving TAs was 2.2% (95% CI 1.0% − 3.7%). In RCTs, a higher incidence of thrombosis (33/1425 vs. 4/680) and higher risk ratios (RR) of overall, arterial, and venous thrombotic events (1.73, 95% CI [0.88, 3.39], P = 0.113; RR 1.98, 95% CI [0.80, 4.92], P = 0.141; RR 1.06, 95% CI [0.46, 2.41], P = 0.895, respectively) were observed in the TAs group than in the control group, although the differences were not significant. Subgroup analysis demonstrated that hetrombopag was the only TA with no increased thrombotic risk (rate 0.3% 95% CI [0.0 − 1.5%]; RR 0.76, 95% CI [0.03, 18.41], P = 0.864) compared to eltrombopag, avatrombopag, romiplostim, and rhTPO. Subgroup analyses also revealed that ITP patients with advanced age (3.7% vs. 1.3%, P = 0.132) or with a thrombotic history (3.0% vs. 1.4%, P = 0.257), and patients who received TAs therapy for a long duration (4.7% vs. 0.1%, P < 0.001) had an increased risk of thrombosis. Our findings suggest ITP patients treated with TAs have a nonsignificantly higher risk of overall, arterial, and venous thrombotic events. Furthermore, hetrombopag is the recommended TA to avoid thrombophilia. Patients receiving long-term TAs, as well as elderly ITP patients or those with a history of thrombosis, face an increased thrombotic risk. In general, clinicians should consider potential thrombotic risks, address underlying risk factors, and ensure ongoing monitoring and follow-up when treating ITP patients with TAs. The online version contains supplementary material available at 10.1186/s12959-023-00509-z.
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影响因子：
2.4
作者：
Reiser, Marcel;Josten, Klaus M.;Dietzfelbinger, Hermann;Seesaghur, Anouchka;Schill, Markus;Hippenmeyer, Jane;Welslau, Manfred
通讯作者：
Welslau, Manfred
DOI：
10.1177/10760296211054514
发表时间：
2021-01
期刊：
Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
影响因子：
--
作者：
Efat A;Shoeib S;Nazir A;Abdelmohsen E;Dawod A;Bedair HM;Elgheriany W
通讯作者：
Elgheriany W
影响因子：
12.8
作者：
Aledort, LM;Hayward, CPM;Bussel, J
通讯作者：
Bussel, J
DOI：
10.3760/cma.j.issn.0253-2727.2013.10.012
发表时间：
2013-10-01
影响因子：
--
作者：
Gu, Shi-yang;Zhuang, Jing-li;Wei, Zheng
通讯作者：
Wei, Zheng
影响因子：
6.5
作者：
Alvarez-Roman, Maria T.;Fernandez-Bello, Ihosvany;Butta, Nora V.
通讯作者：
Butta, Nora V.