Coagulation profiles in patients with immune thrombocytopenia receiving fostamatinib compared to thrombopoietin receptor agonists.
Despite low platelet count and increased bleeding risk, immune thrombocytopenia (ITP) is shown to be a prothrombotic condition with increased venous and arterial thrombosis. The reason for this increased thrombotic risk is not fully understood. Thrombopoietin receptor agonists (TPO-RAs) are among the most widely used agents in ITP patients and considered as the first-choice drugs for ITP patients who fail to achieve adequate response to steroids. However, data have shown that they are associated with increased risk of thromboembolism. Elderly and patients with other risk factors for thromboembolism are particularly vulnerable to develop thromboembolism when they start treatment with TPO-RAs. Fostamatinib, a spleen tyrosine kinase (Syk) inhibitor, has been shown to be safe and effective in elevating platelet count in ITP patients by inhibiting platelet destruction, without increasing the risk of thromboembolism. The underlying mechanisms explaining the difference in thromboembolic risk with the two treatments have not been explored.
Since fostamatinib has a different mechanism, we believe that it does not induce a procoagulant state as the TPO-RAs. We aim to study changes in coagulation profiles and treatment outcomes after initiation of fostamatinib compared to TPO-RAs hypothesizing that fostamatinib is not associated with hypercoagulability.
Lamya Garabet MD PhD is a consultant at the Multidisciplinary Laboratory Medicine and Medical Biochemistry at Akershus University Hospital, Norway, and a postdoctoral researcher at the Center of Laboratory Medicine, Østfold Hospital, Norway. She gained her medical degree from Baghdad University, Iraq. She joined the department of rheumatology at Østfold Hospital, Norway in 1998 and became consultant rheumatologist in 2004. She joined the department of Clinical Chemistry at Østfold Hospital in 2009 and became consultant in clinical chemistry in 2013. She is in charge of coagulation and hemostasis tests. She acquired a PhD degree in 2021. Her work is focused on the effect of thrombopoietin receptor agonists (TPO-RA) on coagulation and fibrinolysis in patients with immune thrombocytopenia (ITP). Her postdoctoral research involves coagulation disturbances in ITP as well as exploring diagnostic and prognostic markers in ITP. She is a member of the research group Thrombosis and Hemostasis in Østfold hospital, which is led by Professor Waleed Ghanima. She has a wide national and international collaborative network.