Department of Hematology, Van Creveldkliniek, University Medical Centre Utrecht, Postbox 85500, 3508 GA Utrecht, The Netherlands.
Education Centre, University Medical Centre Utrecht, Utrecht University, Universiteitsweg 98, 3584 CG Utrecht, The Netherlands.
Blood Rev. 2021 May;47:100774. doi: 10.1016/j.blre.2020.100774. Epub 2020 Nov 10.
Thrombopoietin receptor agonist (TPO-RA) treatment increases the thrombosis rate in immune thrombocytopenia (ITP). We hypothesize that TPO-RAs influence platelet function, global and secondary hemostasis and/or fibrinolysis. A systematic review was performed. If possible, data were compared between responders (relevant increase in platelet count), and non-responders. Twelve observational studies with 305 patients were included (responders (127/150 (85%))). There were indications that TPO-RA treatment enhanced platelet function, with respect to platelet-monocyte aggregates, soluble P-selectin, GPVI expression, and adhesion under flow. Studies addressing global and secondary hemostasis and fibrinolysis were scarce. Overall, no changes were found during TPO-RA treatment, apart from an accelerated clot formation and conflicting data on levels of plasminogen activator inhibitor (PAI)-1. The parameters that increased have previously been associated with thrombosis in other patient groups, and might contribute to the increased rate of thrombosis observed in TPO-RA-treated ITP patients.
血小板生成素受体激动剂（TPO-RA）治疗会增加免疫性血小板减少症（ITP）的血栓形成率。我们假设 TPO-RAs 会影响血小板功能、整体和继发性止血以及/或纤维蛋白溶解。进行了系统评价。如果可能，在应答者（血小板计数有明显增加）和无应答者之间比较数据。共纳入 12 项包含 305 名患者的观察性研究（应答者（127/150（85%）））。有迹象表明，TPO-RA 治疗增强了血小板功能，表现在血小板-单核细胞聚集物、可溶性 P 选择素、GPVI 表达以及在流动条件下的粘附。关于整体和继发性止血以及纤维蛋白溶解的研究很少。总体而言，除了加速凝块形成以及纤溶酶原激活物抑制剂（PAI-1）水平存在相互矛盾的数据外，在 TPO-RA 治疗期间未发现其他变化。以前曾有研究表明，这些增加的参数与其他患者群体的血栓形成有关，可能导致 TPO-RA 治疗的 ITP 患者血栓形成率增加。
