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Catastrophic antiphospholipid syndrome in an immune thrombocytopenia patient treated with avatrombopag
Saartje Van de Vondel1, Christophe Vandenbriele2, Gerald Gheysens3
1Department of Hematology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Background:
Avatrombopag is an orally administered second-generation thrombopoietin receptor agonist (TPO-RA) approved for the treatment of chronic immune thrombocytopenia (ITP). However, increased thrombogenicity in patients with ITP after initiation of TPO-RA treatment has been reported.
Key Clinical Question:
We report a case of a patient with ITP who developed a catastrophic antiphospholipid antibody syndrome (CAPS), following treatment with avatrombopag.
Clinical Approach:
A20-year-old known chronic patient with ITP presented at the emergency department with a 2-week history of headache, nausea, and abdominal pain, 3 weeks after initiating avatrombopag. In-hospital diagnostic work-up revealed multiple microvascular thrombotic events, including myocardial, cerebrovascular, and pulmonary infarctions. Laboratory test results showed a triple-positive antiphospholipid antibodies serology.
Conclusion:
The diagnosis of probable avatrombopag-associated CAPS was made.
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