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ArticleFrontiers in cardiovascular medicine2025

Case Report: Dangerous liaisons between splenectomy and eltrombopag-induced chronic thromboembolic pulmonary hypertension in patients with immune thrombocytopenia: report of two cases and review of the literature.

Roberto Castelli, Enrico Atzori, Alessandro Palmerio Delitala, Salvatore Antonio Masala, Valentina Micheluzzi, Enrico Ponti, Giuseppe Sanna, Dante Castro, Antonio Gidaro, Mattia Donadoni and 5 more

Abstract readCase Reports
In one paragraph

Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

15 authors.

Roberto CastelliDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Enrico AtzoriClinical and Interventional Cardiology, University Hospital, Sassari, Italy.
Alessandro Palmerio DelitalaDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Salvatore Antonio MasalaDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Valentina MicheluzziClinical and Interventional Cardiology, University Hospital, Sassari, Italy.
Enrico PontiDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Giuseppe SannaDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Dante CastroDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Antonio GidaroDepartment of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Mattia DonadoniDepartment of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Roberto ManettiDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Pierluigi MerellaClinical and Interventional Cardiology, University Hospital, Sassari, Italy.
Nicia Isabella ProfiliDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Andrea Maria D'ArminiCardiac Surgery, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Gavino CasuDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Primary immune thrombocytopenia is an autoimmune bleeding disorder characterized by variable immune-mediated platelet destruction. These patients have reported thrombotic complications, both venous and arterial, in addition to bleeding. Splenectomy and thrombopoietin receptor agonists are recommended for patients who do not respond to steroids or immunosuppressive treatments. Chronic thromboembolic pulmonary hypertension is a rare disease that results from a persistent, organized thromboembolic obstruction of the pulmonary arteries due to an incompletely resolved pulmonary embolism. Case presentations: We report two cases of chronic thromboembolic pulmonary hypertension induced by a thrombotic mechanism after treatment with splenectomy and Eltrombopag, a thrombopoietin receptor agonist, for refractory primary immune thrombocytopenia. Consequently, the patients were referred for surgical pulmonary thromboendarterectomy therapy as suggested. Conclusion: In older patients, those with a history of thrombotic manifestations, or those with high-risk factors, clinicians should evaluate and monitor the risk of thrombotic events and chronic thromboembolic pulmonary hypertension when treating primary immune thrombocytopenia with splenectomy and Eltrombopag.

Indexed as

chronic thromboembolic pulmonary hypertensioneltrombopagprimary immune thrombocytopeniapulmonary thromboendarterectomysplenectomythrombopoietin receptors agonists

Identifiers

PMID40013124
PMCPMC11861326

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