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

Autor:	Chowdhury SR; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada., Sirotich E; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada., Guyatt G; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada.; MAGIC Evidence Ecosystem Foundation, Oslo, Norway., Gill D; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Modi D; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada., Venier LM; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Mahamad S; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada., Chowdhury MR; Department of Public Health, North South University, Dhaka, Bangladesh., Eisa K; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Beck CE; Division of Paediatric Medicine, Department of Paediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada., Breakey VR; Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, Canada., de Wit K; Department of Emergency Medicine, Queen's University, Kingston, Canada.; Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada., Porter S; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Webert KE; Canadian Blood Services, Ancaster, Canada.; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada., Cuker A; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA., O'Connor C; Faculty of Health Sciences, McMaster University, Hamilton, Canada., -DiRaimo JM; Platelet Disorder Support Association (PDSA), Cleveland, Ohio, USA., Yan JW; Lawson Health Research Institute, London Health Sciences Centre, Western University, London, Canada., Manski C; Northwestern University, Evanston, Illinois, USA., Kelton JG; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada., Kang M; Joseph Brant Hospital, Burlington, Canada., Strachan G; Platelet Disorder Support Association (PDSA), Cleveland, Ohio, USA., Hassan Z; Saskatchewan Health Authority, Saskatoon, Canada., Pruitt B; Platelet Disorder Support Association (PDSA), Cleveland, Ohio, USA., Pai M; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada., Grace RF; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA., Paynter D; Platelet Disorder Support Association (PDSA), Cleveland, Ohio, USA., Charness J; Platelet Disorder Support Association (PDSA), Cleveland, Ohio, USA., Cooper N; Department of Inflammation and Immunity, Imperial College London, London, UK., Fein S; Heme on Call, Telemedicine-Based Hematology Practice, Miami, Florida, USA., Agarwal A; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada., Nazaryan H; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Siddiqui I; Faculty of Health Sciences, McMaster University, Hamilton, Canada., Leong R; Faculty of Health Sciences, McMaster University, Hamilton, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada., Pallapothu S; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.; OrthoEvidence, Burlington, Canada., Wen A; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Xu E; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Liu B; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Shafiee A; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Rathod P; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Kwon H; Department of Surgery, Henry Ford Health, Detroit, Michigan, USA., Dookie J; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada., Zeraatkar D; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.; Department of Anesthesia, McMaster University, Hamilton, Canada., Thabane L; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.; Division of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Canada.; Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada., Couban R; Department of Anesthesia, McMaster University, Hamilton, Canada., Arnold DM; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Canada.; Department of Medicine, McMaster University, Hamilton, Canada.
Jazyk:	angličtina
Zdroj:	European journal of haematology [Eur J Haematol] 2024 Nov 18. Date of Electronic Publication: 2024 Nov 18.
DOI:	10.1111/ejh.14351
Abstrakt:	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. (© 2024 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.)
Databáze:	MEDLINE
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