IMMUNE THROMBOSITOPENIC PURPURA (ITP)

Primary Therapy For ITP: Steroid (Prednison)  gagal  splenectomy  gagal  TPO ??

EITHROMBOPAG?

Safety Events of Special Interest:

 Two patients receiving Eithrombopag had on-treatment thromboembolic events

 Hepatobiliary laboratory abnormalities were observed in a small number of patients:
o ALT increased to ≥3x ULN: nine patients in the Eithrombopag group and two patients in
the control group
 All resolved either whilst on treatment or after discontinuation
o Total bilirubin increased to >1.5x ULN in five (4%) patients in the Eithrombopag group
and none in the control group
 No clinivally significant differences between groups were noted in progression of existing or
formation of new cataracts or malignant disease
THROMBOPROPHYLAXIS FOR MEDICAL PATIENTS

 For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend
anticoagulant thromboprophylaxis with LMWH, low-dose unfractionated heparin (LDUH)
bid, LDUH tid, or fandaparinux (Grade 1B).
 For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis over no
prophylaxis (Grade 2C).

MANAGEMENT OF DVT

Goal: to prevent complications of VTE

 Pulmonary emboli  sudden death

 Pulmonary hypertension
 Post thrombotic syndrome
 Chronic venous ulcer
TREATMENT OF THROMBOSIS IN CANCER

 Options for the initial treatment of cancer-associated thrombosis include LMWH,

unfractionated heparin (UFH) and fondaparinux
 Features specific to oncology patients that contribute to bleeding: the extent, location,
meed for invasive diagnostic or treatment procedures, thrombocytopenia from
chemotherapy or from the underlying malignancy.

Conclusion

 Prevention of VTE is an important issue in at-risk hospitalized medical patients

 Risk assessment for every hospitalized patient for the indentification of individuals at high
risk for thrombosis
 Management of VTE: to prevent complications of VTE
 Duration of the anticoagulant and regular assessment of the risk factor(s)  “safe and
effective”
SCORING
ANTICOAGULANT IN CANCER PATIENTS

 In patients with cancer-associated thrombosis initial treatment should be with LMWH for 6
months, if tolerated (1A)
 Warfarin and other oral anticoagulants are acceptable alternatives of LMWH is impractical
and anticoagulation is indicated (1A)
 An IVC filter should only be inserted when there is a strong contraindication to
anticoagulation and should be removed is possible as soon as anticoagulation is possible
(2C)
 In the presence of active malignancy, anticoagulation should be continued, taking patient
status and wishes and bleeding risk into consideration. There is a rational but little direct
evidence fot preferring to continue to use LMWH (2B)