1. Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults
- Author
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M.‐L. Piel‐Julian, M. Mahévas, J. Germain, L. Languille, T. Comont, M. Lapeyre‐Mestre, B. Payrastre, O. Beyne‐Rauzy, M. Michel, B. Godeau, D. Adoue, G. Moulis, L. Alric, S. Arista, L. Astudillo, L. Balardy, S. Betrian, D. Bonnet, C. Borel, D. Brechemier, N. Brun, M. Carreiro, B. Castel, L. Caudrelier, P. Cougoul, A. Danu, K. Delavigne, C. Dingremont, T. Faurie, F. Gaches, M.‐H. Gaspard, C. Gaudin, A. Godel‐Labouret, P. Giraud, S. Hadj‐Khelifa, B. Hebraud, S. Khatibi, L. Leplay, Y. Leveneur, N. Limal, S. Ollier, S. Madaule, B. Marchou, C. Martel, G. Martin‐Blondel, P. Montane De La Roque, M. Michaud, J. Moeglin, F. Nuccio, L. Prudhomme, G. Pugnet, C. Recher, V. Remy, L. Sailler, S. Sire, A. Sommet, S. Tavitian, M.‐F. Thiercelin‐Legrand, W. Vaillant, Centre hospitalier universitaire de Toulouse-Purpan, CHU Henri Mondor, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM, Service de Pharmacologie Médicale et Clinique, CHU Toulouse [Toulouse]-Centre d'Investigation Clinique, INSERM U1048 (I2CM), CHU de Toulouse, Laboratoire d'Hématologie, CHU Toulouse [Toulouse], Pagès, Nathalie, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Pharmacologie Clinique [CHU Toulouse], Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Hématologie - IUCT-Oncopole [CHU Toulouse], Pôle Biologie [CHU Toulouse], and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle IUCT [CHU Toulouse]
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,[SDV]Life Sciences [q-bio] ,Newly diagnosed ,Comorbidity ,030204 cardiovascular system & hematology ,Logistic regression ,Gastroenterology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,Epidemiology ,Medicine ,Humans ,risk factors ,Platelet ,Mucosal bleeding ,Aged ,Aged, 80 and over ,Purpura, Thrombocytopenic, Idiopathic ,Receiver operating characteristic ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Anticoagulants ,Hematology ,Middle Aged ,platelet count ,Immune thrombocytopenia ,3. Good health ,[SDV] Life Sciences [q-bio] ,Cross-Sectional Studies ,idiopathic thrombocytopenic purpura ,ROC Curve ,030220 oncology & carcinogenesis ,Area Under Curve ,Female ,epidemiology ,hemorrhage ,business ,Selective Serotonin Reuptake Inhibitors - Abstract
International audience; Essentials Risk factors of bleeding in adult immune thrombocytopenia are not known. This multicenter study assessed risk factors of bleeding at immune thrombocytopenia onset. Platelet count thresholds associated with bleeding were < 20 × 109 L-1 and < 10 × 109 L-1 . Exposure to anticoagulants was a major risk factor of severe bleeding.Summary: Background The aim of this cross-sectional study was to assess risk factors for bleeding in immune thrombocytopenia (ITP) adults, including the determination of platelet count thresholds. Methods We selected all newly diagnosed ITP adults included in the Cytopénies Auto-immunes Registre Midi-PyrénéEN (CARMEN) register and at the French referral center for autoimmune cytopenias. The frequencies of any bleeding, mucosal bleeding and severe bleeding (gastrointestinal, intracranial, or macroscopic hematuria) at ITP onset were assessed. Platelet count thresholds were assessed by the use of receiver operating characteristic curves. All potential risk factors were included in logistic regression models. Results Among the 302 patients, the frequencies of any, mucosal and severe bleeding were 57.9%, 30.1%, and 6.6%, respectively. The best discriminant threshold of platelet count for any bleeding was 20 × 109 L-1 . In multivariate analysis, factors associated with any bleeding were platelet count (< 10 × 109 L-1 versus ≥ 20 × 109 L-1 , odds ratio [OR] 48.2, 95% confidence interval [CI] 20.0-116.3; between 10 × 109 L-1 and 19 × 109 L-1 versus ≥ 20 × 109 L-1 , OR 5.2, 95% CI 2.3-11.6), female sex (OR 2.6, 95% CI 1.3-5.0), and exposure to non-steroidal anti-inflammatory drugs (NSAIDs) (OR 4.8, 95% CI 1.1-20.7). A low platelet count was also the main risk factor for mucosal bleeding. Exposure to anticoagulant drugs was associated with severe bleeding (OR 4.3, 95% CI 1.3-14.1). Conclusions Platelet counts of < 20 × 109 L-1 and < 10 × 109 L-1 were thresholds for major increased risks of any and mucosal bleeding. Platelet count, female sex and exposure to NSAIDs should be considered for assessment of the risk of any bleeding. Exposure to anticoagulant drugs was a major risk factor for severe bleeding.
- Published
- 2018