Catastrophic antiphospholipid syndrome in an immune thrombocytopenia patient treated with avatrombopag

Saartje Van de Vondel; Christophe Vandenbriele; Gerald Gheysens; Peter Verhamme; Ann Janssens

doi:10.1016/j.rpth.2023.100125

Catastrophic antiphospholipid syndrome in an immune thrombocytopenia patient treated with avatrombopag

Res Pract Thromb Haemost. 2023 Mar 15;7(3):100125. doi: 10.1016/j.rpth.2023.100125. eCollection 2023 Mar.

Authors

Saartje Van de Vondel¹, Christophe Vandenbriele², Gerald Gheysens³, Peter Verhamme², Ann Janssens¹

Affiliations

¹ Department of Hematology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
² Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
³ Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

Abstract

Background: Avatrombopag is an orally administered second-generation thrombopoietin receptor agonist (TPO-RA) approved for the treatment of chronic immune thrombocytopenia (ITP). However, increased thrombogenicity in patients with ITP after initiation of TPO-RA treatment has been reported.

Key clinical question: We report a case of a patient with ITP who developed a catastrophic antiphospholipid antibody syndrome (CAPS), following treatment with avatrombopag.

Clinical approach: A20-year-old known chronic patient with ITP presented at the emergency department with a 2-week history of headache, nausea, and abdominal pain, 3 weeks after initiating avatrombopag. In-hospital diagnostic work-up revealed multiple microvascular thrombotic events, including myocardial, cerebrovascular, and pulmonary infarctions. Laboratory test results showed a triple-positive antiphospholipid antibodies serology.

Conclusion: The diagnosis of probable avatrombopag-associated CAPS was made.

Publication types

Case Reports