How Frequent Are ITP-Related Bleeding Events in the Elderly?

Bleeding events are to be expected in patients with primary immune thrombocytopenia (ITP), but the average time before the first episode may be sooner than you think.

ITP is categorized by low platelet count and increased bleeding tendency. Elderly patients with ITP may have an increased bleeding risk in comparison to their younger counterparts. Shuling Li, PhD, from the Chronic Disease Research Group in Minnesota, and colleagues set out to find a real-world estimate of bleeding risk episodes (BREs). The data was presented at the 57^th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida

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For the study, the researchers used elderly Medicare patients who were newly diagnosed with ITP. “We included 3,007 patients and more than 55% female,” Li explained during the presentation. All of the patients were at least 67-years-old without preexisting thrombocytopenia at index date.

BRE was defined as at least one bleeding event of any severity and/or use of rescue or emergency therapies for ITP. A single BRE was considered claims with relevant codes with dates of service separated by no more than three days. The team tracked the BRE type as bleeding event only, therapy use only, or both.

The findings collected from 2007 to 2012 revealed an average follow-up of 2.1 years. During that time, 73% (2,202 patients) had at least one BRE with a total of 9,096 BREs.

“The rate was highest during the first three months,” Li specified. From months three to 12 there were about half as frequent BREs.

Nearly half of all BREs were found to be therapy use alone, however, bleeding only events followed in a close second. Patients who BREs classified as both made up a much lower percentage. Common types of bleeds were identified in the population: gastrointestinal bleeding, hematuna, epistaxis, and ecchymoses. Intracranial hemorrhage occurred in 5% (151 patients).

“Overall, elderly Medicare patients newly diagnosed with ITP experienced nearly two BREs per patient-year,” Li explained. “The majority of BREs were managed in an outpatient setting.”

The outcomes from this real-world study give insight to physicians treating elderly patients with ITP and how it can be applied to clinical practice.

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