Can you use TPO-RAs in patients with ITP and positive APLAs?¶
Answer: Carefully and with important considerations.
The largest study is retrospective, from the French CARMEN registry — 80 patients with ITP secondary to SLE and/or APS. Thrombotic event (TE) rates after starting a TPO-RA:
- SLE without APLA — 8.1%
- SLE with APLA — 22.2%
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APS — 50%, all of whom had previous thrombosis; this subgroup also produced 3 cases of catastrophic APS (CAPS)
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LAC was present in the majority of patients with thrombosis.
- Limitations are real: small numbers, selection bias.
On whether the drug must be stopped after a TE:
Among patients who continued TPO-RAs after a TE with anticoagulation, only 1 of 9 experienced a recurrent event
The authors read that as reassuring. One in nine is still a high failure rate.
Related: 0008 — IVIG in ITP and thrombosis risk — the same question in a different drug: does treating the ITP raise thrombotic risk, or does the untreated disease?