P129 | IMMUNE THROMBOCYTOPENIA AND ANTICOAGULANT/ANTIPLATELET THERAPIES: BALANCING HEMORRHAGIC RISK MANAGEMENT AND THROMBOTIC RISK MANAGEMENT – A RETROSPECTIVE STUDY

INTRODUCTION: Managing anticoagulation and antiplatelet therapy in patients with immune thrombocytopenia (ITP) is complex. A low platelet count increases bleeding risk but does not necessarily protect against thrombotic events. This study aims to document our center’s experience in managing antiplatelet and anticoagulant therapy in ITP patients. MATERIALS AND METHODS: We included ITP patients requiring treatment and concomitant anticoagulant or antiplatelet therapy. Clinical data were collected using outpatient and inpatient records (Tab.1). Diagnosis and Treatment response were evaluated using the 2019 ASH criteria. Bleeding was classified according to the IWG’s bleeding assessment scale. To evaluate thrombotic and hemorrhagic risks the TH2 score (Balitsky et al,Blood, 2018) was used. RESULTS: From August 2011 to December 2024 31 ITP patients receiving anticoagulant or antiplatelet therapy were enrolled (Tab2-3). The median follow-up was 28 months (range 2–109). All patients were treated to achieve platelet counts above 50,000/mm³. 97% of patients received steroids; however 74% required second-line therapies with thrombopoietin (TPO) mimetics with an overall response rate of 87%. Anticoagulation was interrupted in 21 patients when platelet counts were <40,000/mm³. The median interruption duration was 33 days. No major hemorrhagic events occurred in patients who continued anticoagulation or antiplatelet therapy, except for one case of subdural hemorrhage in a patient on antiplatelet therapy with a platelet count >50,000/mm³. 25% of patients (8/31) had mild hemorrhagic events (Grade 1-3), everyone had platelet count <20.000/mmc. Thrombotic events occurred in 28% of patients(9/31); In 5 cases at diagnosis/relapse, and in 4 during treatment with TPO mimetics. 3 patients were already on anticoagulation therapy. At time of treatment TH2 Score estimated a thrombotic risk profile in 90% of patients (54% had positive score and 36% had null score); 67% of patients with thrombotic events (6/9) had in that moment an increase in their TH2 score. CONCLUSIONS: In the absence of definitive data, this study showed that in ITP patients on anticoagulation, severe hemorrhagic events were rare, even though most of these patients had a thrombotic risk profile. Tools like the TH2 score could be useful in managing thrombotic risk. Future research should focus on identifying specific tools to estimate individual hemorrhagic or thrombotic risks and refine treatment decisions.