Unmasking the link: pulmonary embolism risk and outcomes in adults with immune thrombocytopenia

Immune thrombocytopenia (ITP) is known to increase bleeding risk, yet thrombotic complications, including pulmonary embolism (PE), remain overlooked, with limited clinical evidence.

This study aimed to characterize PE in patients with ITP and offer insights for clinical management.

We conducted a retrospective nested case-control study based on a cohort of 7281 adult patients with primary ITP between 2011 and 2025. For each patient with ITP and PE, 3 patients with PE-free ITP were randomly matched by sex, age, time of ITP diagnosis, and follow-up duration. Clinical characteristics, treatment modalities, and outcomes were analyzed and compared. Cox regression analyses were performed to identify potential risk factors.

Twenty-five patients with PE were identified, with an incidence of 0.46 per 1000 person-years. The median age at PE diagnosis was 65 years, with a median of 199 days from ITP diagnosis to PE onset. At the time of PE diagnosis, 76% of the patients had achieved an ITP treatment response. Early anticoagulant therapy resulted in favourable outcomes, whereas 2 patients died within 30 days of PE diagnosis. Cox regression analysis revealed that a history of thrombosis (hazard ratio, 6.123; P = .002) and concurrent active malignancy (hazard ratio, 4.468; P = .045) were independent risk factors for PE following ITP diagnosis. Additional analyses identified factors associated with bleeding or thrombosis recurrence.

This study provided insights into PE in adults with ITP, highlighted the risk factors, and summarized the experience regarding clinical management, which may help optimize outcomes for affected patients.

NCT07068425.