Bleeding Risk Factors Identified for ITP

July 11, 2018

Low platelet counts, exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulants, and female sex are associated with increased risk for bleeding events in adults with immune thrombocytopenia (ITP), according to new research.

To conduct their study, the researchers identified 302 adult patients with a new diagnosis of ITP who were listed in the CARMEN register and were receiving care at the French referral center for autoimmune cytopenias.


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They assessed frequency of bleeds, mucosal bleeding, and severe bleeding—such as gastro-intestinal, intracranial, or macroscopic hematuria—at the time of ITP onset.

Overall, 57.9% of participants had experienced a bleed of any type, 30.1% had experienced a mucosal bleed, and 6.6% had experienced a severe bleed.

Participants with a platelet count of less than 10 × 109/L vs 20 × 109/L or more had an odds ratio of 48.2 for any bleed. Those with a platelet count between 10 and 19 × 109/L vs 20 × 109/L or more had an odds ratio of 5.2 for any bleed.

Women had an odds ratio of 2.6 for any bleed, and participants who were taking NSAIDs had an odds ratio of 4.8 for any bleed.

“Platelet counts <20 × 109/L and <10 × 109/L were thresholds with major increased risks of any and mucosal bleeding,” the researchers conclude. “Platelet count, female sex, and exposure to NSAIDs should be considered to assess the risk of any bleeding. Exposure to anticoagulant drugs was a major risk factor for severe bleeding.”

—Amanda Balbi


Piel‐Julian ML, Mahévas M, Germain J, et al; The CARMEN investigators group. Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults [published online July 6, 2018]. J Thromb Haemost. doi:10.1111/jth.14227.



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