Evidence map›Paper›PMID 29295846›Full record

ReviewBlood2018

Splenectomy for immune thrombocytopenia: down but not out.

Shruti Chaturvedi, Donald M Arnold, Keith R McCrae

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Blood, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 3 pooled it
14.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

86 citing papers in PubMed, 3 syntheses or guidelines pooled it, 194 citations in OpenAlex.

  1. Guideline
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26 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 2 countries.

Shruti ChaturvediDivision of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Donald M ArnoldDivision of Hematology and Thromboembolism, Michael G. DeGroote School of Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada; and.
Keith R McCraeDepartment of Hematology-Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.ORCID 0000-0001-7340-475X
Cleveland Clinic · USJohns Hopkins University · USMcMaster University · CA

Funding

Efficacy of Pomalidomide in HHT-related bleedingU34HL123416 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI MCCRAE, KEITH R. · 2014 to 2016
$727k
NHLBI NIH HHS U34 HL123416
6 · The paper itself

Abstract

Splenectomy is an effective therapy for steroid-refractory or dependent immune thrombocytopenia (ITP). With the advent of medical alternatives such as rituximab and thrombopoietin receptor antagonists, the use of splenectomy has declined and is generally reserved for patients that fail multiple medical therapies. Splenectomy removes the primary site of platelet clearance and autoantibody production and offers the highest rate of durable response (50% to 70%) compared with other ITP therapies. However, there are no reliable predictors of splenectomy response, and long-term risks of infection and cardiovascular complications must be considered. Because the long-term efficacy of different second-line medical therapies for ITP have not been directly compared, treatment decisions must be made without supportive evidence. Splenectomy continues to be a reasonable treatment option for many patients, including those with an active lifestyle who desire freedom from medication and monitoring, and patients with fulminant ITP that does not respond well to medical therapy. We try to avoid splenectomy within the first 12 months after ITP diagnosis for most patients to allow for spontaneous or therapy-induced remissions, particularly in older patients who have increased surgical morbidity and lower rates of response, and in young children. Treatment decisions must be individualized based on patients' comorbidities, lifestyles, and preferences. Future research should focus on comparing long-term outcomes of patients treated with different second-line therapies and on developing personalized medicine approaches to identify subsets of patients most likely to respond to splenectomy or other therapeutic approaches.

Indexed as

SplenectomyHumansPurpura, Thrombocytopenic, IdiopathicReceptors, ThrombopoietinRituximabMPL protein, humanReceptors, ThrombopoietinRituximab

Identifiers

PMID29295846
PMCPMC5855018
OpenAlexW2781917933

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.