Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France.
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
Br J Haematol. 2022 Mar;196(5):1262-1270. doi: 10.1111/bjh.17935. Epub 2021 Nov 5.
Data about the presentation and the management of primary immune thrombocytopenia (ITP) in very elderly patients (VEPs; aged ≥80 years) are lacking. The aim of the present study was to describe ITP in this subgroup. The data source was the prospective CARMEN-France registry. Patients included between 2013 and 2018 were selected. ITP presentation and management in VEPs was compared to elderly patients (EPs; aged 65-79 years). We assessed factors associated with bleeding at ITP onset in VEPs. Of 541 patients, 184 were included: 87 in the VEP group and 97 in the EP group. The mean age was 85·7 years in the VEP group. Comorbidities were more frequent in the VEP group (67·4% vs. 47·9%). The median platelet count at ITP onset was similar but severe bleeding tended to be more frequent in VEPs (10·3% vs. 4·1%, P = 0·1) as well as mortality. Exposure to ITP drugs, response to first-line treatment, need of second-line treatment, evolution towards persistency, occurrence of bleeding, infection and thrombosis did not differ between groups. In VEPs, factors associated to bleeding were female sex [odds ratio (OR) 4·75, 95% confidence interval (CI) 1·31-17·32] and platelet count of <20 × 10 /l (OR 10·05, 95% CI 4·83-67·39). Exposure to anticoagulants was strongly associated with severe bleeding (OR 7·61, 95% CI 1·77-32·83).
有关非常老年患者（VEP；年龄≥80 岁）原发性免疫性血小板减少症（ITP）表现和管理的数据缺乏。本研究旨在描述该亚组的 ITP。数据源为前瞻性 CARMEN-France 登记处。选择了 2013 年至 2018 年之间的患者。比较了 VEP 中 ITP 的表现和管理与老年患者（EPs；年龄 65-79 岁）。我们评估了 VEP 中 ITP 发病时出血相关的因素。在 541 名患者中，有 184 名患者入组：VEP 组 87 名，EP 组 97 名。VEP 组的平均年龄为 85.7 岁。VEP 组的合并症更为常见（67.4% vs. 47.9%）。ITP 发病时血小板计数中位数相似，但 VEP 中严重出血更为常见（10.3% vs. 4.1%，P=0.1），死亡率也更高。两组之间 ITP 药物暴露、一线治疗反应、二线治疗需求、向持续性发展、出血、感染和血栓形成的发生率无差异。在 VEP 中，出血的相关因素为女性（比值比 [OR] 4.75，95%置信区间 [CI] 1.31-17.32）和血小板计数<20×10 /l（OR 10.05，95% CI 4.83-67.39）。抗凝剂暴露与严重出血强烈相关（比值比 [OR] 7.61，95%置信区间 [CI] 1.77-32.83）。
