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Role of Laparoscopic Splenectomy in Elderly Immune Thrombocytopenia
- Source :
- Open Medicine, Vol 11, Iss 1, Pp 361-368 (2016)
- Publication Year :
- 2016
- Publisher :
- De Gruyter, 2016.
-
Abstract
- The management of older patients with chronic primary immune thrombocytopenia (ITP) is still very challenging because of the fragility of older patients who frequently have severe comorbidities and/or disabilities. Corticosteroid-based first-line therapies fail in most of the cases and patients require a second-line treatment, choosing between rituximab, thrombopoietin-receptor agonists and splenectomy. The choice of the best treatment in elderly patients is a compromise between effectiveness and safety and laparoscopic splenectomy may be a good option with a complete remission rate of 67% at 60 months. But relapse and complication rates remain higher than in younger splenectomized ITP patients because elderly patients undergo splenectomy with unfavorable conditions (age >60 year-old, presence of comorbidities, or multiple previous treatments) which negatively influence the outcome, regardless the hematological response. For these reasons, a good management of concomitant diseases and the option to not use the splenectomy as the last possible treatment could improve the outcome of old splenectomized patients.
- Subjects :
- Immune thrombocytopenia
Splenectomy
Laparoscopy
Elderly
Medicine
Subjects
Details
- Language :
- English
- ISSN :
- 23915463
- Volume :
- 11
- Issue :
- 1
- Database :
- Directory of Open Access Journals
- Journal :
- Open Medicine
- Publication Type :
- Academic Journal
- Accession number :
- edsdoj.8ed5c50fbfdf434dabfdcd6181e2ab2e
- Document Type :
- article
- Full Text :
- https://doi.org/10.1515/med-2016-0066