Primary immune thrombocytopenia in very elderly patients: particularities in presentation and management: results from the prospective CARMEN-France Registry

Data about the presentation and the management of primary immune thrombocytopenia (ITP) in very elderly patients (VEPs; aged >= 80 years) are lacking. The aim of the present study was to describe ITP in this subgroup. The data source was the prospective CARMEN-France registry. Patients included between 2013 and 2018 were selected. ITP presentation and management in VEPs was compared to elderly patients (EPs; aged 65-79 years). We assessed factors associated with bleeding at ITP onset in VEPs. Of 541 patients, 184 were included: 87 in the VEP group and 97 in the EP group. The mean age was 85 center dot 7 years in the VEP group. Comorbidities were more frequent in the VEP group (67 center dot 4% vs. 47 center dot 9%). The median platelet count at ITP onset was similar but severe bleeding tended to be more frequent in VEPs (10 center dot 3% vs. 4 center dot 1%, P = 0 center dot 1) as well as mortality. Exposure to ITP drugs, response to first-line treatment, need of second-line treatment, evolution towards persistency, occurrence of bleeding, infection and thrombosis did not differ between groups. In VEPs, factors associated to bleeding were female sex [odds ratio (OR) 4 center dot 75, 95% confidence interval (CI) 1 center dot 31-17 center dot 32] and platelet count of <20 x 10(9)/l (OR 10 center dot 05, 95% CI 4 center dot 83-67 center dot 39). Exposure to anticoagulants was strongly associated with severe bleeding (OR 7 center dot 61, 95% CI 1 center dot 77-32 center dot 83).