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Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults
Author(s): ,
M.‐L. Piel‐Julian
Affiliations:
Service de Médecine Interne, Salle Le Tallec, Centre Hospitalier Universitaire de Toulouse‐Purpan, Toulouse, France
,
M. Mahévas
Affiliations:
Service de Médecine Interne, CHU Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris, Centre de Référence des Cytopénies Auto‐Immunes de l'adulte, Université Paris‐Est‐Créteil, Créteil, France
,
J. Germain
Affiliations:
Centre d'Investigation Clinique 1436, Axe Pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse‐Purpan, Toulouse, France
,
L. Languille
Affiliations:
Service de Médecine Interne, CHU Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris, Centre de Référence des Cytopénies Auto‐Immunes de l'adulte, Université Paris‐Est‐Créteil, Créteil, France
,
T. Comont
Affiliations:
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse – Oncopôle, Toulouse, France
,
M. Lapeyre‐Mestre
Affiliations:
Centre d'Investigation Clinique 1436, Axe Pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse‐Purpan, Toulouse, France. UMR 1027, INSERM‐Université de Toulouse, Toulouse, France. Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
,
B. Payrastre
Affiliations:
Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, Toulouse, France. Laboratoire d'Hématologie, CHU de Toulouse, Toulouse, France
,
O. Beyne‐Rauzy
Affiliations:
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse – Oncopôle, Toulouse, France
,
M. Michel
Affiliations:
Service de Médecine Interne, CHU Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris, Centre de Référence des Cytopénies Auto‐Immunes de l'adulte, Université Paris‐Est‐Créteil, Créteil, France
,
B. Godeau
Affiliations:
Service de Médecine Interne, CHU Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris, Centre de Référence des Cytopénies Auto‐Immunes de l'adulte, Université Paris‐Est‐Créteil, Créteil, France
,
D. Adoue
Affiliations:
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse – Oncopôle, Toulouse, France
,
G. Moulis
Affiliations:
Service de Médecine Interne, Salle Le Tallec, Centre Hospitalier Universitaire de Toulouse‐Purpan, Toulouse, France. Centre d'Investigation Clinique 1436, Axe Pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse‐Purpan, Toulouse, France. UMR 1027, INSERM‐Université de Toulouse, Toulouse, France
Correspondence: Guillaume Moulis, INSERM UMR 1027, Pharmacoepidemiology Unit, 37 Allées Jules Guesde, 31000 Toulouse, France|Tel.: +33 56 114 5606|E‐mail: moulis.g@chu-toulouse.fr
,

Affiliations:
L. Alric
,
L. Alric
Affiliations:
S. Arista
,
S. Arista
Affiliations:
L. Astudillo
,
L. Astudillo
Affiliations:
L. Balardy
,
L. Balardy
Affiliations:
S. Betrian
,
S. Betrian
Affiliations:
D. Bonnet
,
D. Bonnet
Affiliations:
C. Borel
,
C. Borel
Affiliations:
D. Brechemier
,
D. Brechemier
Affiliations:
N. Brun
,
N. Brun
Affiliations:
M. Carreiro
,
M. Carreiro
Affiliations:
B. Castel
,
B. Castel
Affiliations:
L. Caudrelier
,
L. Caudrelier
Affiliations:
P. Cougoul
,
P. Cougoul
Affiliations:
A. Danu
,
A. Danu
Affiliations:
K. Delavigne
,
K. Delavigne
Affiliations:
C. Dingremont
,
C. Dingremont
Affiliations:
T. Faurie
,
T. Faurie
Affiliations:
F. Gaches
,
F. Gaches
Affiliations:
M.‐H. Gaspard
,
M.‐H. Gaspard
Affiliations:
C. Gaudin
,
C. Gaudin
Affiliations:
A. Godel‐Labouret
,
A. Godel‐Labouret
Affiliations:
P. Giraud
,
P. Giraud
Affiliations:
S. Hadj‐Khelifa
,
S. Hadj‐Khelifa
Affiliations:
B. Hebraud
,
B. Hebraud
Affiliations:
S. Khatibi
,
S. Khatibi
Affiliations:
L. Leplay
,
L. Leplay
Affiliations:
Y. Leveneur
,
Y. Leveneur
Affiliations:
N. Limal
,
N. Limal
Affiliations:
S. Ollier
,
S. Ollier
Affiliations:
S. Madaule
,
S. Madaule
Affiliations:
B. Marchou
,
B. Marchou
Affiliations:
C. Martel
,
C. Martel
Affiliations:
G. Martin‐Blondel
,
G. Martin‐Blondel
Affiliations:
P. Montane De La Roque
,
P. Montane De La Roque
Affiliations:
M. Michaud
,
M. Michaud
Affiliations:
J. Moeglin
,
J. Moeglin
Affiliations:
F. Nuccio
,
F. Nuccio
Affiliations:
L. Prudhomme
,
L. Prudhomme
Affiliations:
G. Pugnet
,
G. Pugnet
Affiliations:
C. Recher
,
C. Recher
Affiliations:
V. Remy
,
V. Remy
Affiliations:
L. Sailler
,
L. Sailler
Affiliations:
S. Sire
,
S. Sire
Affiliations:
A. Sommet
,
A. Sommet
Affiliations:
S. Tavitian
,
S. Tavitian
Affiliations:
M.‐F. Thiercelin‐Legrand
,
M.‐F. Thiercelin‐Legrand
Affiliations:
W. Vaillant
W. Vaillant
Affiliations:
ISTH Academy. Moulis G. Sep 4, 2018; 230957
Dr. Guillaume Moulis
Dr. Guillaume Moulis

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Journal Abstract
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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 × 10 L. In multivariate analysis, factors associated with any bleeding were platelet count (< 10 × 10 L versus ≥ 20 × 10 L, odds ratio [OR] 48.2, 95% confidence interval [CI] 20.0–116.3; between 10 × 10 L and 19 × 10 L versus ≥ 20 × 10 L, 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 × 10 L and < 10 × 10 L 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.
Keyword(s)
epidemiology, hemorrhage, idiopathic thrombocytopenic purpura, platelet count, risk factors
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