Saifur R Chowdhury, Emily Sirotich, Gordon Guyatt, Daya Gill, Dimpy Modi, Laura M Venier, Syed Mahamad, Mahmudur Rahman Chowdhury, Kerolos Eisa, Carolyn E Beck, Vicky R Breakey, Kerstin de Wit, Stephen Porter, Kathryn E Webert, Adam Cuker, Clare O'Connor, Jennifer MacWhirter -DiRaimo, Justin W Yan, Charles Manski, John G Kelton, Matthew Kang, Gail Strachan, Ziauddin Hassan, Barbara Pruitt, Menaka Pai, Rachael F Grace, Dale Paynter, Jay Charness, Nichola Cooper, Steven Fein, Arnav Agarwal, Hasmik Nazaryan, Ishaq Siddiqui, Russell Leong, Sushmitha Pallapothu, Aaron Wen, Emily Xu, Bonnie Liu, Amirmohammad Shafiee, Preksha Rathod, Henry Kwon, Jared Dookie, Dena Zeraatkar, Lehana Thabane, Rachel Couban, Donald M Arnold
{"title":"免疫性血小板减少症患者严重出血的治疗：系统回顾。","authors":"Saifur R Chowdhury, Emily Sirotich, Gordon Guyatt, Daya Gill, Dimpy Modi, Laura M Venier, Syed Mahamad, Mahmudur Rahman Chowdhury, Kerolos Eisa, Carolyn E Beck, Vicky R Breakey, Kerstin de Wit, Stephen Porter, Kathryn E Webert, Adam Cuker, Clare O'Connor, Jennifer MacWhirter -DiRaimo, Justin W Yan, Charles Manski, John G Kelton, Matthew Kang, Gail Strachan, Ziauddin Hassan, Barbara Pruitt, Menaka Pai, Rachael F Grace, Dale Paynter, Jay Charness, Nichola Cooper, Steven Fein, Arnav Agarwal, Hasmik Nazaryan, Ishaq Siddiqui, Russell Leong, Sushmitha Pallapothu, Aaron Wen, Emily Xu, Bonnie Liu, Amirmohammad Shafiee, Preksha Rathod, Henry Kwon, Jared Dookie, Dena Zeraatkar, Lehana Thabane, Rachel Couban, Donald M Arnold","doi":"10.1111/ejh.14351","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Systematic review registration: </strong>CRD42020161206.</p>","PeriodicalId":11955,"journal":{"name":"European Journal of Haematology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Treatment of Critical Bleeds in Patients With Immune Thrombocytopenia: A Systematic Review.\",\"authors\":\"Saifur R Chowdhury, Emily Sirotich, Gordon Guyatt, Daya Gill, Dimpy Modi, Laura M Venier, Syed Mahamad, Mahmudur Rahman Chowdhury, Kerolos Eisa, Carolyn E Beck, Vicky R Breakey, Kerstin de Wit, Stephen Porter, Kathryn E Webert, Adam Cuker, Clare O'Connor, Jennifer MacWhirter -DiRaimo, Justin W Yan, Charles Manski, John G Kelton, Matthew Kang, Gail Strachan, Ziauddin Hassan, Barbara Pruitt, Menaka Pai, Rachael F Grace, Dale Paynter, Jay Charness, Nichola Cooper, Steven Fein, Arnav Agarwal, Hasmik Nazaryan, Ishaq Siddiqui, Russell Leong, Sushmitha Pallapothu, Aaron Wen, Emily Xu, Bonnie Liu, Amirmohammad Shafiee, Preksha Rathod, Henry Kwon, Jared Dookie, Dena Zeraatkar, Lehana Thabane, Rachel Couban, Donald M Arnold\",\"doi\":\"10.1111/ejh.14351\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>The effects of individual treatments on patient outcomes were uncertain due to very low-quality evidence. 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Treatment of Critical Bleeds in Patients With Immune Thrombocytopenia: A Systematic Review.
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.
期刊介绍：
European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.
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