免疫性血小板减少症患者严重出血的治疗：一项系统评价

Treatment of Critical Bleeds in Patients With Immune Thrombocytopenia: A Systematic Review.

作者信息

Chowdhury Saifur R, Sirotich Emily, Guyatt Gordon, Gill Daya, Modi Dimpy, Venier Laura M, Mahamad Syed, Chowdhury Mahmudur Rahman, Eisa Kerolos, Beck Carolyn E, Breakey Vicky R, de Wit Kerstin, Porter Stephen, Webert Kathryn E, Cuker Adam, O'Connor Clare, -DiRaimo Jennifer MacWhirter, Yan Justin W, Manski Charles, Kelton John G, Kang Matthew, Strachan Gail, Hassan Ziauddin, Pruitt Barbara, Pai Menaka, Grace Rachael F, Paynter Dale, Charness Jay, Cooper Nichola, Fein Steven, Agarwal Arnav, Nazaryan Hasmik, Siddiqui Ishaq, Leong Russell, Pallapothu Sushmitha, Wen Aaron, Xu Emily, Liu Bonnie, Shafiee Amirmohammad, Rathod Preksha, Kwon Henry, Dookie Jared, Zeraatkar Dena, Thabane Lehana, Couban Rachel, Arnold Donald M

机构信息

Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.

出版信息

Eur J Haematol. 2025 Mar;114(3):458-468. doi: 10.1111/ejh.14351. Epub 2024 Nov 18.

DOI:10.1111/ejh.14351

PMID:39552264

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11798764/

Abstract

OBJECTIVES

Evidence-based protocols for managing bleeding emergencies in patients with immune thrombocytopenia (ITP) are lacking. We conducted a systematic review of treatments for critical bleeding in patients with ITP.

METHODS

We included all study designs and extracted data in aggregate or individually for patients who received one or more interventions and for whom any of the following outcomes were reported: platelet count response, bleeding, disability, or death.

RESULTS

We identified 49 eligible studies reporting 112 critical bleed patients with ITP, including 66 children (median age, 10 years), 36 adults (median age, 41.5 years), and 10 patients with unreported age. Patients received corticosteroids (n = 67), IVIG (n = 49), platelet transfusions (n = 41), TPO-RAs (n = 17), and splenectomy (n = 28) either alone or in combination. Studies reported 29 different treatment combinations, the 5 most common were corticosteroids, platelet transfusion and splenectomy (n = 13), corticosteroids and IVIG (n = 13), or splenectomy alone (n = 13); IVIG alone (n = 11); and corticosteroids, IVIG and TPO-RA (n = 8). Mortality among patients with critical bleeds in ITP was 30.6% for adults and 19.7% for children.

CONCLUSIONS

The effects of individual treatments on patient outcomes were uncertain due to very low-quality evidence. There is a need for a standardized approach to the treatment of ITP critical bleeds.

SYSTEMATIC REVIEW REGISTRATION

CRD42020161206.

摘要

目的

缺乏用于管理免疫性血小板减少症（ITP）患者出血急症的循证方案。我们对ITP患者严重出血的治疗进行了系统评价。

方法

我们纳入了所有研究设计，并汇总或单独提取接受一种或多种干预措施且报告了以下任何一项结果的患者的数据：血小板计数反应、出血、残疾或死亡。

结果

我们确定了49项符合条件的研究，报告了112例ITP严重出血患者，其中包括66名儿童（中位年龄10岁）、36名成人（中位年龄41.5岁）和10名年龄未报告的患者。患者单独或联合接受了皮质类固醇（n = 67）、静脉注射免疫球蛋白（IVIG，n = 49）、血小板输注（n = 41）、促血小板生成素受体激动剂（TPO-RAs，n = 17）和脾切除术（n = 28）。研究报告了29种不同的治疗组合，最常见的5种是皮质类固醇、血小板输注和脾切除术（n = 13）、皮质类固醇和IVIG（n = 13）、或单独脾切除术（n = 13）；单独IVIG（n = 11）；以及皮质类固醇、IVIG和TPO-RA（n = 8）。ITP严重出血患者的死亡率在成人中为30.6%，在儿童中为19.7%。