A practical guide to the management of immune thrombocytopenia co-existing with acute coronary syndrome

Document Type

Article

Publication Title

Frontiers in medicine

Abstract

INTRODUCTION: Immune thrombocytopenia (ITP) management with co-existing acute coronary syndrome (ACS) remains challenging as it requires a clinically relevant balance between the risk and outcomes of thrombosis and the risk of bleeding. However, the literature evaluating the treatment approaches in this high-risk population is scarce. METHODS AND RESULTS: In this review, we aimed to summarize the available literature on the safety of ITP first- and second-line therapies to provide a practical guide on the management of ITP co-existing with ACS. We recommend holding antithrombotic therapy, including antiplatelet agents and anticoagulation, in severe thrombocytopenia with a platelet count < 30 × 10/L and using a single antiplatelet agent when the platelet count falls between 30 and 50 × 10/L. We provide a stepwise approach according to platelet count and response to initial therapy, starting with corticosteroids, with or without intravenous immunoglobulin (IVIG) with a dose limit of 35 g, followed by thrombopoietin receptor agonists (TPO-RAs) to a target platelet count of 200 × 10/L and then rituximab. CONCLUSION: Our review may serve as a practical guide for clinicians in the management of ITP co-existing with ACS.

First Page

1348941

DOI

10.3389/fmed.2024.1348941

Publication Date

1-1-2024

Identifier

38665297 (pubmed); PMC11043582 (pmc); 10.3389/fmed.2024.1348941 (doi)

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