Primary immune thrombocytopenia in very elderly patients: particularities in presentation and management: results from the prospective CARMEN-France Registry
Corresponding Author
Aurélien Sokal
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Correspondence: Aurélien Sokal, Service de Médecine Interne, CHU Henri-Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
E-mail: [email protected]
Search for more papers by this authorThomas de Nadaï
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Search for more papers by this authorJulien Maquet
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Search for more papers by this authorThibault Comont
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
Search for more papers by this authorNicolas Limal
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorMarc Michel
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorOdile Beyne-Rauzy
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
Search for more papers by this authorBertrand Godeau
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorDaniel Adoue
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
Search for more papers by this authorMatthieu Mahévas
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorGuillaume Moulis
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Centre d’Investigation Clinique 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Search for more papers by this authorthe CARMEN investigators group
The members of CARMEN investigators group are presented in Appendix 1.
Search for more papers by this authorCorresponding Author
Aurélien Sokal
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Correspondence: Aurélien Sokal, Service de Médecine Interne, CHU Henri-Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
E-mail: [email protected]
Search for more papers by this authorThomas de Nadaï
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Search for more papers by this authorJulien Maquet
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Search for more papers by this authorThibault Comont
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
Search for more papers by this authorNicolas Limal
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorMarc Michel
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorOdile Beyne-Rauzy
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
Search for more papers by this authorBertrand Godeau
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorDaniel Adoue
Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
Search for more papers by this authorMatthieu Mahévas
Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
Search for more papers by this authorGuillaume Moulis
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Centre d’Investigation Clinique 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Search for more papers by this authorthe CARMEN investigators group
The members of CARMEN investigators group are presented in Appendix 1.
Search for more papers by this authorSummary
Data about the presentation and the management of primary immune thrombocytopenia (ITP) in very elderly patients (VEPs; aged ≥80 years) are lacking. The aim of the present study was to describe ITP in this subgroup. The data source was the prospective CARMEN-France registry. Patients included between 2013 and 2018 were selected. ITP presentation and management in VEPs was compared to elderly patients (EPs; aged 65–79 years). We assessed factors associated with bleeding at ITP onset in VEPs. Of 541 patients, 184 were included: 87 in the VEP group and 97 in the EP group. The mean age was 85·7 years in the VEP group. Comorbidities were more frequent in the VEP group (67·4% vs. 47·9%). The median platelet count at ITP onset was similar but severe bleeding tended to be more frequent in VEPs (10·3% vs. 4·1%, P = 0·1) as well as mortality. Exposure to ITP drugs, response to first-line treatment, need of second-line treatment, evolution towards persistency, occurrence of bleeding, infection and thrombosis did not differ between groups. In VEPs, factors associated to bleeding were female sex [odds ratio (OR) 4·75, 95% confidence interval (CI) 1·31–17·32] and platelet count of <20 × 109/l (OR 10·05, 95% CI 4·83–67·39). Exposure to anticoagulants was strongly associated with severe bleeding (OR 7·61, 95% CI 1·77–32·83).
Conflict of interest
Guillaume Moulis received research grants from Amgen, CSL Behring, Grifols and Novartis, meeting attendance grants from Amgen and Novartis, participated to boards for Amgen, Novartis and Sobi and to educational sessions for Amgen and Novartis. Bertrand Godeau received a grant from Roche and personal fees from Amgen, LFB, Novartis, GSK. Daniel Adoue received personal fees from Amgen, Novartis, GSK. All other authors declare having no conflict of interest.
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