Abdelsamia Mahmoud, Farid Saira, Dean Steven, Cataland Spero R
Department of Medicine, Michigan State University, East Lansing, MI 48824, USA.
Department of Medicine, Ohio State University, Columbus, OH 43210, USA.
Hematol Rep. 2023 Sep 12;15(3):518-523. doi: 10.3390/hematolrep15030054.
Avatrombopag is a novel oral non-peptide thrombopoietin receptor agonist (TPO-RA) that was approved by the FDA as a second-line therapy for chronic immune thrombocytopenia (cITP). Avatrombopag has shown promising results in regards to efficacy and tolerability, but to our knowledge, there are no reports of thrombotic complications associated with avatrombopag. We present two patients with chronic ITP who suffered thromboembolic events shortly after starting treatment with avatrombopag. The first case is that of a 30-year-old female with refractory cITP who failed multiple lines of ITP therapy and was hospitalized with an intracranial bleed. The patient eventually recovered after an emergent splenectomy but subsequently developed a right lower lobe pulmonary embolism three weeks after starting treatment with avatrombopag. The second case is that of a 58-year-old female with a prolonged history of ITP, and no prior history of peripheral vascular disease, who suffered from both arterial and venous thrombotic events four weeks after starting avatrombopag. Given the new arterial and venous thrombotic complications, avatrombopag was stopped. She was challenged with avatrombopag again and developed yet another thrombotic complication.
阿伐曲泊帕是一种新型口服非肽类血小板生成素受体激动剂（TPO-RA），已被美国食品药品监督管理局（FDA）批准作为慢性免疫性血小板减少症（cITP）的二线治疗药物。阿伐曲泊帕在疗效和耐受性方面已显示出有前景的结果，但据我们所知，尚无与阿伐曲泊帕相关的血栓形成并发症的报道。我们报告了两名慢性ITP患者，他们在开始使用阿伐曲泊帕治疗后不久发生了血栓栓塞事件。第一例是一名30岁的难治性cITP女性患者，她接受了多线ITP治疗均失败，并因颅内出血住院。患者最终在紧急脾切除术后康复，但在开始使用阿伐曲泊帕治疗三周后出现了右下叶肺栓塞。第二例是一名58岁的ITP病史较长且无外周血管疾病既往史的女性患者，她在开始使用阿伐曲泊帕四周后发生了动脉和静脉血栓形成事件。鉴于出现了新的动脉和静脉血栓形成并发症，停用了阿伐曲泊帕。再次对她使用阿伐曲泊帕进行激发试验时，又出现了另一种血栓形成并发症。
