Queen Elizabeth Hospital, Birmingham, UK.
New Cross Hospital, Heath Town, Wolverhampton, UK.
J Thromb Haemost. 2018 Mar;16(3):474-480. doi: 10.1111/jth.13940. Epub 2018 Feb 5.
Essentials We estimated the cardiovascular risk of patients with idiopathic thrombocytopenic purpura (ITP). The risk of cardiovascular disease was 38% higher in ITP patients compared with controls. Among the ITP patients, splenectomy was associated with higher cardiovascular disease. Clinicians should consider cardiovascular risk when managing ITP patients.
Background Idiopathic thrombocytopenic purpura (ITP) is classically characterized by a transient or persistent decrease of platelet count. Mortality is higher in the ITP population than the general population, with a possible association with increased cardiovascular disease (CVD). Objectives The objective was to assess the strength of the association between ITP and CVD, with a secondary aim to assess the impact of splenectomy on CVD. Methods A population-based retrospective, open cohort study using clinical codes was performed using data from 6591 patients with ITP and 24 275 randomly matched controls (up to 1:4 ratio matched by age, sex, body mass index and smoking status). The main outcome was the risk of CVD, which included ischemic heart disease, stroke, trans-ischemic attack and heart failure. Adjusted incidence rate ratios were calculated using Poisson regression. Results During a median 6-year observation period there was a CVD diagnosis recorded in 392 (5.9%) ITP patients and 1114 (4.5%) control patients. There was an increased risk of developing CVD in the ITP cohort (incidence rate ratio [IRR], 1.38; 95% confidence interval [CI], 1.23-1.55), which remained robust even after a sensitivity analysis only including incident cases of ITP. Findings suggested that patients who had undergone splenectomy were at even further increased risk of developing CVD when compared with the ITP population who had not undergone splenectomy (adjusted IRR, 1.69; 95% CI, 1.22-2.34). Conclusion There is an increased risk of developing CVD in patients with ITP and even further increased risk for those patients with ITP who underwent splenectomy.
本研究旨在评估特发性血小板减少性紫癜（ITP）患者发生心血管疾病（CVD）的风险，并探讨脾切除术对 CVD 的影响。
这是一项基于人群的回顾性、开放性队列研究，使用临床代码从 6591 例 ITP 患者和 24275 名随机匹配的对照者（按年龄、性别、体重指数和吸烟状况进行 1:4 比例匹配）中提取数据。主要结局是 CVD 的发病风险，包括缺血性心脏病、卒中等。采用泊松回归计算调整后的发病率比（IRR）。
在中位 6 年的观察期内，392 例（5.9%）ITP 患者和 1114 例（4.5%）对照者被诊断为 CVD。与对照组相比，ITP 患者发生 CVD 的风险增加（IRR，1.38；95%CI，1.23-1.55），即使在仅纳入首发 ITP 病例的敏感性分析中，结果仍具有稳健性。研究结果提示，与未行脾切除术的 ITP 患者相比，行脾切除术的 ITP 患者发生 CVD 的风险进一步增加（调整后的 IRR，1.69；95%CI，1.22-2.34）。
ITP 患者发生 CVD 的风险增加，而行脾切除术的 ITP 患者发生 CVD 的风险进一步增加。
