How are bleeding risk factors managed in the treatment of immune thrombocytopenia (ITP) in adults?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Additional precautions are required for patients with hypertension, peptic ulcers, recent aspirin ingestion, or other risk factors for increased bleeding. Considerations are as follows:

  • Aspirin inhibits platelet function by acetylating platelet cyclooxygenase, increasing the risk of bleeding because it adds a prolonged platelet functional defect to the quantitative defect already present from the severe thrombocytopenia. In addition, platelet dysfunction may be induced by the platelet antibody, which is potentiated by the superimposition of the aspirin-platelet defect. Because of this effect, aspirin is contraindicated in persons with ITP.

  • Adults whose platelet counts are greater than 50× 109/L typically have minimal purpura, and the risk of a severe or life-threatening hemorrhage is low. They may be treated without a specific medication.

  • Platelet transfusions may be required to control clinically significant or catastrophic bleeding but are not recommended for prophylaxis. Transfused platelets have decreased circulation time, and repeated platelet transfusions may lead to platelet alloimmunization.


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