Analysis of cardiovascular risk factors in a cohort of patients with ITP in a tertiary care center Free

INTRODUCTION

There is a higher risk of thrombosis in ITP compared to general population, but little is known about the risk factors (RF) for thrombosis in these patients, except in splenectomises. Lambert et al¹ (Eur J Haematol. 2023, DOI 10.1111/ejh.14154) report RF common to those in general population and emphasize the importance of personalized approach, with adequate control of comorbidities in these patients.

OBJECTIVE

To evaluate cardiovascular RF (RFCV) in a cohort of adults with ITP as part of their comprehensive care.

MATERIAL AND METHODS

Retrospective collection of data from electronic medical records of 55 adults followed in the outpatient clinic of 3rd level center. Data analysis with ChatGPT4o (OpenAI), which proposes statistical analyses based on the data collected. Our results are compared with those reported by Gonçalves et al², RPTH (2024), https://doi.org/10.1016/j.rpth.2024.102342, Zhou et al³, Hematology (2025), https://doi.org/10.1080/16078454.2025.2472461 and Lambert et al.

RESULTS

We analised 31 men and 24 women. Mean Age ± SD: 63.4 ± 19.5 years, Median (IQR): 67.5 (47.0–78.0) years. Patients ≥60 years have higher prevalence of CVRF, use of agonists, and higher frequency of thrombotic events (27.3% vs 4.5%). Mean age of patients who suffer a thrombotic event is 77.6 years (median 79.0) vs. 60.2 years (median 64) for patients without thrombosis (p 0.0066, Mann-Whitney). Advanced age is a thrombotic RF in patients with ITP, similar to that reported in literature^1,2,3, especially when combined with other CVRFs. Arterial Hypertension (HTN) is present in <60 years: 4.8% and in ≥60 years: 54.5% (p = 0.0006, Chi²) consistent with all previous studies^1,3. Dyslipidemia (PLD) affects 19% in <60 years and in ≥60 years: 54.5% (p = 0.0212, Chi²) aligned with data from Zhou et al. Diabetes mellitus (DM) is not present in <60 years and in ≥60 years: 24.2% (p = 0.0402, Chi²), reinforcing that patients >60 accumulate more CVRF, in a similar way to general population. Atrial Fibrillation is only observed in >60 years (24.2%), similar described in 1, 3. In relation to obesity, there are no differences between those < and ≥60 years (12.1% vs 14.3% respectively, p = 1, Chi²). In relation to AMI, there are no differences (p = 1, Chi²), probably due to small sample size. In relation to TIA/stroke, although the difference isn´t statistically significant (p = 0.26, Chi²), it does show a trend in ≥60 years (12.1%) in line with literature. Those ≥60 years old use more agonists, but it does not reach significance (p= 0.2031, Chi²) but it may be due to clinical bias to treat older adults with relapse more aggressively, or by chance. There are no statistically significant differences between men and women regarding the incidence of RFCV in this cohort (p = 1, Chi²) in line with previous studies (^1,2,3), where sex was not an independent predictor of thrombotic risk. A reduced logistic regression model was constructed to identify independent predictors of thrombotic events: Age: OR 1.04 (p = 0.191), RCV Index ≥2: OR 2.83 (p = 0.256) and use of agonists: OR 2.66 (p = 0.409) (Chi²). Although none of the variables reached statistical significance (by sample size), all showed a trend consistent with the clinical and bibliographic findings.

CONCLUSIONS

Our cohort of patients with ITP shows a clinical and risk pattern that is very much aligned with international series. Older age and the accumulation of CVRF (especially HTN, DM, and AF) appear to increase the likelihood of thrombotic events, and could influence the choice and duration of treatment, particularly with R-TPO-agonists. Although the low number of events limits statistical significance, the results reinforce the need for individualized stratification of thrombotic risk in ITP, as proposed by the most recent international studies.