Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis
Abstract Background There is an emerging understanding of the increased risk of stroke in patients with immune thrombocytopenic purpura (ITP) and immune thrombotic thrombocytopenic purpura (iTTP). We aimed to determine the prevalence and characteristics of acute ischemic stroke (AIS) and intracrania...
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BMC
2025-03-01
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| Series: | Neurological Research and Practice |
| Online Access: | https://doi.org/10.1186/s42466-025-00374-3 |
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| author | Syed Ameen Ahmad Olivia Liu Amy Feng Andrew Kalra Apurva Dev Marcus Spann Aaron M. Gusdon Shruti Chaturvedi Sung-Min Cho |
| author_facet | Syed Ameen Ahmad Olivia Liu Amy Feng Andrew Kalra Apurva Dev Marcus Spann Aaron M. Gusdon Shruti Chaturvedi Sung-Min Cho |
| author_sort | Syed Ameen Ahmad |
| collection | DOAJ |
| description | Abstract Background There is an emerging understanding of the increased risk of stroke in patients with immune thrombocytopenic purpura (ITP) and immune thrombotic thrombocytopenic purpura (iTTP). We aimed to determine the prevalence and characteristics of acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) in patients with ITP and iTTP in a systematic review and meta-analysis. Methods We used PubMed, Embase, Cochrane, Web of Science, and Scopus using text related to ITP, iTTP, stroke, AIS, and ICH from inception to 11/3/2023. Our primary outcome was to determine prevalence of AIS and/or ICH in a cohort of ITP or iTTP patients (age > 18). Our secondary outcomes were to determine stroke type associated with thrombopoietin receptor agonists (TPO-RAs) in ITP patients, as well as risk factors associated with stroke in ITP and iTTP patients. Results We included 42 studies with 118,019 patients (mean age = 50 years, 45% female). Of those, 27 studies (n = 116,334) investigated stroke in ITP patients, and 15 studies (n = 1,685) investigated stroke in iTTP patients. In all ITP patients, the prevalence of AIS and ICH was 2.1% [95% Confidence Interval (CI) 0.8-4.0%] and 1.5% (95% CI 0.9%-2.1%), respectively. ITP patients who experienced stroke as an adverse event (AE) from TPO-RAs had an AIS prevalence of 1.8% (95% CI 0.6%-3.4%) and an ICH prevalence of 2.0% (95% CI 0.2%-5.3%). Prevalence of stroke did not significantly differ between all ITP patients and those treated with TPO-RAs. iTTP patients had a prevalence of AIS and ICH of 13.9% (95% CI 10.2%-18.1%) and 3.9% (95% CI 0.2%-10.4%), respectively. Subgroup analysis revealed the prevalence of AIS and ICH was greater in iTTP patients vs. all ITP patients (p < 0.01 and p = 0.02, respectively). Meta-regression analysis revealed none of the collected variables (age, sex, history of diabetes or hypertension) were risk factors for stroke in all ITP patients, although there were high levels of data missingness. Conclusions Prevalence of different stroke types was lower in all ITP patients vs. iTTP patients. Additionally, ITP patients experienced a similar prevalence of stroke regardless of if they were specifically denoted to have been treated with TPO-RAs or not, supporting the continued use of TPO-RAs in management. Risk factors for stroke remain unclear, and future studies should continue to investigate this relationship. |
| format | Article |
| id | doaj-art-001ab11e58734ff8a334eede297cd42a |
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| series | Neurological Research and Practice |
| spelling | doaj-art-001ab11e58734ff8a334eede297cd42a2025-08-20T01:48:38ZengBMCNeurological Research and Practice2524-34892025-03-017111110.1186/s42466-025-00374-3Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysisSyed Ameen Ahmad0Olivia Liu1Amy Feng2Andrew Kalra3Apurva Dev4Marcus Spann5Aaron M. Gusdon6Shruti Chaturvedi7Sung-Min Cho8Division of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of MedicineDivision of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of MedicineDivision of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of MedicineDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of MedicineDivision of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of MedicineInformationist Services, Johns Hopkins School of MedicineDivision of Neurocritical Care, Department of Neurosurgery, McGovern School of Medicine, University of Texas Health Science CenterDivision of Hematology, Department of Medicine, School of Medicine, Johns Hopkins UniversityDivision of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of MedicineAbstract Background There is an emerging understanding of the increased risk of stroke in patients with immune thrombocytopenic purpura (ITP) and immune thrombotic thrombocytopenic purpura (iTTP). We aimed to determine the prevalence and characteristics of acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) in patients with ITP and iTTP in a systematic review and meta-analysis. Methods We used PubMed, Embase, Cochrane, Web of Science, and Scopus using text related to ITP, iTTP, stroke, AIS, and ICH from inception to 11/3/2023. Our primary outcome was to determine prevalence of AIS and/or ICH in a cohort of ITP or iTTP patients (age > 18). Our secondary outcomes were to determine stroke type associated with thrombopoietin receptor agonists (TPO-RAs) in ITP patients, as well as risk factors associated with stroke in ITP and iTTP patients. Results We included 42 studies with 118,019 patients (mean age = 50 years, 45% female). Of those, 27 studies (n = 116,334) investigated stroke in ITP patients, and 15 studies (n = 1,685) investigated stroke in iTTP patients. In all ITP patients, the prevalence of AIS and ICH was 2.1% [95% Confidence Interval (CI) 0.8-4.0%] and 1.5% (95% CI 0.9%-2.1%), respectively. ITP patients who experienced stroke as an adverse event (AE) from TPO-RAs had an AIS prevalence of 1.8% (95% CI 0.6%-3.4%) and an ICH prevalence of 2.0% (95% CI 0.2%-5.3%). Prevalence of stroke did not significantly differ between all ITP patients and those treated with TPO-RAs. iTTP patients had a prevalence of AIS and ICH of 13.9% (95% CI 10.2%-18.1%) and 3.9% (95% CI 0.2%-10.4%), respectively. Subgroup analysis revealed the prevalence of AIS and ICH was greater in iTTP patients vs. all ITP patients (p < 0.01 and p = 0.02, respectively). Meta-regression analysis revealed none of the collected variables (age, sex, history of diabetes or hypertension) were risk factors for stroke in all ITP patients, although there were high levels of data missingness. Conclusions Prevalence of different stroke types was lower in all ITP patients vs. iTTP patients. Additionally, ITP patients experienced a similar prevalence of stroke regardless of if they were specifically denoted to have been treated with TPO-RAs or not, supporting the continued use of TPO-RAs in management. Risk factors for stroke remain unclear, and future studies should continue to investigate this relationship.https://doi.org/10.1186/s42466-025-00374-3 |
| spellingShingle | Syed Ameen Ahmad Olivia Liu Amy Feng Andrew Kalra Apurva Dev Marcus Spann Aaron M. Gusdon Shruti Chaturvedi Sung-Min Cho Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis Neurological Research and Practice |
| title | Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis |
| title_full | Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis |
| title_fullStr | Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis |
| title_full_unstemmed | Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis |
| title_short | Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis |
| title_sort | prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura a systematic review and meta analysis |
| url | https://doi.org/10.1186/s42466-025-00374-3 |
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