American Society of Hematology 2019 guidelines for immune thrombocytopenia
| Autor: | Hayley Shimanek, Keith R. McCrae, Rachael F. Grace, Barbara Pruitt, Cindy Neunert, James N. George, Adam Cuker, Wendy Lim, Sara K. Vesely, Deirdra R. Terrell, Jenny M. Despotovic, Douglas B. Cines, Thomas Kühne, George R. Buchanan, Nichola Cooper, David J. Kuter, Donald M. Arnold |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Consensus MEDLINE 030204 cardiovascular system & hematology History 21st Century law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Bone Marrow Multidisciplinary approach law Internal medicine Health care medicine Humans Grading (education) Intensive care medicine Purpura Thrombocytopenic Idiopathic Hematology business.industry Guideline Middle Aged Thrombocytopenia United States 030220 oncology & carcinogenesis Rituximab business Clinical Guidelines medicine.drug |
| Zdroj: | Blood advances. 3(23) |
| ISSN: | 2473-9537 |
| Popis: | Background:Despite an increase in the number of therapies available to treat patients with immune thrombocytopenia (ITP), there are minimal data from randomized trials to assist physicians with the management of patients.Objective:These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the management of ITP.Methods:In 2015, ASH formed a multidisciplinary guideline panel that included 8 adult clinical experts, 5 pediatric clinical experts, 2 methodologists with expertise in ITP, and 2 patient representatives. The panel was balanced to minimize potential bias from conflicts of interest. The panel reviewed the ASH 2011 guideline recommendations and prioritized questions. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence (up to May 2017) and formulate recommendations.Results:The panel agreed on 21 recommendations covering management of ITP in adults and children with newly diagnosed, persistent, and chronic disease refractory to first-line therapy who have non–life-threatening bleeding. Management approaches included: observation, corticosteroids, IV immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists.Conclusions:There was a lack of evidence to support strong recommendations for various management approaches. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making, especially with regard to second-line therapy. Future research should apply standard corticosteroid-dosing regimens, report patient-reported outcomes, and include cost-analysis evaluations. |
| Databáze: | OpenAIRE |
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