Clinical profiling and outcomes of ischaemic stroke patients with immune thrombocytopenia: A multicentre retrospective study.

To investigate the risk factors, treatment strategies and prognosis in patients with acute ischaemic stroke (AIS) after immune thrombocytopenia (ITP), we conducted a multicentre case-control study. One hundred and thirteen adult ITP patients with AIS were included, and each ITP-AIS was paired with three control subjects. The ITP-AIS cohort had a median age of 65 (24-97) years, was predominately female (61 vs. 52) and had a median platelet count of 44 × 109/L (range: 4-355 × 109/L) at the time of AIS. Post-infarction treatment included anti-platelet therapy (n = 36, 31.9%), anti-coagulation therapy (n = 4, 3.5%), combined anti-platelet-anti-coagulation therapy (n = 4, 3.5%) and endovascular thrombectomy (n = 1, 0.9%). Haemorrhagic transformation occurred in 5 (4.4%) patients. Three patients (2.7%) died due to intracranial haemorrhage, gastrointestinal haemorrhage or severe pulmonary infection. Multivariate analysis revealed that age greater than 60 years (p < 0.001; odds ratio [OR] 3.12; 95% confidence interval [CI] 1.82-5.37), diabetes mellitus (p = 0.018; OR 1.99; 95% CI 1.13-3.52), hypertension (p < 0.001; OR 2.75; 95% CI 1.62-4.66), renal failure (p = 0.036; OR 3.00; 95% CI 1.08-8.38), smoking (p < 0.001; OR 5.02; 95% CI 2.31-10.88) and hyper-low-density lipoprotein (LDL)-C (p = 0.02; OR 2.34; 95% CI, 1.14-4.78) were independent risk factors for AIS after ITP. This study revealed that ITP-related treatments might not increase the risk of ITP-AIS. The management of ITP-AIS patients requires close collaboration between haematologists and vascular neurologists to carefully balance therapeutic benefits against the risk of haemorrhagic complications.