Abstract Number: PB1334
Meeting: ISTH 2020 Congress
Background: Splenectomy may lead to a good response in 60-80% of adults with immune thrombocytopenia (ITP). However, available literature does not seem to contain any precise indications concerning possible factors predicting the response to splenectomy.
Aims: To perform systematic review and meta-analysis in an attempt to identify predictive parameters for good therapy response (GTR) on splenectomy in adult ITP patients.
Methods: MEDLINE, Web of Science, EMBASE, Cochrane trials and reviews were searched from 1966 to 2018 for studies where splenectomised ITP patients were followed to determine predictive parameters for GTR. The primary analysis included all papers. During secondary analyses papers were divided in groups according to used response criteria (first used International Working Group (IWG) criteria; second defined GTR as platelet count (PC)>50×109/L). Both groups were subdivided according to the tested type of response: initial, sustained remission and relapse. Random effects method was used to summarise outcomes. The effect estimates were expressed as odds ratio (OR) or standardised mean difference (SMD) with 95% confidence interval. Strength of evidence was assessed by New-Castle Otawa protocol.
Results: The literature search identified 8451 articles; 35 of them were included in meta-analysis (IWG group included 16 articles and second group 19 articles). Meta-analysis did not reveal any significant predictor for successful splenectomy, in both primary and secondary analysis (p>0.05). Age, sex, the time between diagnosis and surgery, response to steroids, response to IVGs, preoperative PC, antiplatelet antibody, spleen weight, accessory spleen, number of therapy lines, and platelet kinetic were not significantly correlated with response to splenectomy. Low quality of evidence was found for all outcomes.
Conclusions: Our study did not identify any parameter clearly predictive of GTR after splenectomy. Further studies based on appropriate use of standardised criteria for patient recruitment and outcomes are needed to better define splenectomy effect persistence in long term.
To cite this abstract in AMA style:Mitrovic M, Antic D, Milic N, Virijevic M, Pravdic Z, Sabljic N, Pantic N, Suvajdzic Vukovic N. Can we Predict the Outcome of Splenectomy for Primary Immune Thrombocytopenia? Conclusion Based on Systematic Review and Meta-Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/can-we-predict-the-outcome-of-splenectomy-for-primary-immune-thrombocytopenia-conclusion-based-on-systematic-review-and-meta-analysis/. Accessed December 6, 2023.
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