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Evidence summaries

Treatments for ITP and Persistent Thrombocytopenia after Splenectomy

Immunosuppressive treatments may have only very modest effect in patients with ITP and persistent thrombocytopenia after splenectomy. Level of evidence: "C"

A systematic review 1 including 90 studies with a total of 656 subjects was abstracted in DARE. Eighty-nine of these studies were cohort studies or uncontrolled case series. One study was an RCT but the randomisation was not relevant to the review question. Across all treatments, 14% of patients achieved a complete response, 40% a partial response and 46% no response. The largest numbers of complete responses were reported with azathioprine (18 out of 109; 17%), cyclophosphamide (22 out of 83; 27%) and rituximab (10 out of 41; 24%). However, 36 to 42% of the patients had no response to these three treatments.

    References

    • Vesely SK, Perdue JJ, Rizvi MA, Terrell DR, George JN. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy: a systematic review. Ann Intern Med 2004 Jan 20;140(2):112-20. [PubMed] [DARE]

Primary/Secondary Keywords