Premier Hematology and Tele-Oncology Center, PLLC, Cary, North Carolina, USA.
Duke Regional Hospital, Durham, North Carolina, USA.
Acta Haematol. 2022;145(2):221-228. doi: 10.1159/000520438. Epub 2021 Dec 14.
Patients with immune thrombocytopenia (ITP) are at increased risk for bleeding and are paradoxically at increased risk for thrombosis. Many patients with ITP have underlying cardiovascular (CV) disease and/or other thrombotic risk factors for which considerable attention to selecting a therapeutic agent to manage ITP is needed. Fostamatinib, a spleen tyrosine kinase inhibitor, may reduce the risk of thrombosis while not interfering with hemostasis. We present a case series of 5 patients with ITP who had significant CV histories; each had at least 2 thrombotic risk factors. After unsuccessful management of ITP with other treatments, fostamatinib was initiated, was observed to be tolerable, and provided a durable platelet response without associated thromboembolic events. Fostamatinib may be the treatment of choice for patients with ITP in whom use of prothrombotic treatments should be avoided and/or continued use of antiplatelet or anticoagulant medication is needed.
患有免疫性血小板减少症（ITP）的患者出血风险增加，而血栓形成风险却增加了。许多 ITP 患者存在潜在的心血管（CV）疾病和/或其他血栓形成危险因素，需要对选择治疗药物来管理 ITP 给予充分关注。脾酪氨酸激酶抑制剂 fostamatinib 可降低血栓形成的风险，同时不干扰止血。我们报告了 5 例 ITP 患者的病例系列，这些患者均有严重的 CV 病史；每个人都至少有 2 个血栓形成危险因素。在其他治疗方法未能成功治疗 ITP 后，开始使用 fostamatinib，观察到该药物耐受性良好，并提供了持久的血小板反应，而没有相关的血栓栓塞事件。对于 ITP 患者，fostamatinib 可能是首选治疗药物，这些患者应避免使用促血栓形成的治疗药物，并且/或者需要继续使用抗血小板或抗凝药物。
