Treatment of ITP in Patients w Cardiovascular Disease

Hello,
I am new to this site but have found many of your comments very instructive. Thank you. Hopefully, your collective experiences will shed some light on my situation. I have both chronic ITP (currently 12K) and cardiovascular disease with multiple stents. In order to minimize platelet activity at stent sites (which can lead to more heart disease and be fatal) I take 81 mg aspirin and Plavix. My platelet number (12) has my hematologist concerned about potential bleeding, especially in the brain which also can be fatal. I currently have no signs of bleeding or bruising. Rituximab treatment has been strongly suggested by the hematologists. I am having a difficult time deciding whether to commence treatment with Rituximab given the counterproductive effect of high platelet activity on my cardiovascular system and disturbing my somewhat stable state. I am also concerned about any toxic effect killing off of B cells and potential consequent infections may have on my heart and health. Any thoughts/suggestions are most welcome. Thank you.

Stephen:
Hi. We haven't had many people here over the years who have had both ITP and heart issues. There were a few years ago but none lately, so you may not get much help. A lot of us do have multiple health issues, but not that particular one. It can be difficult to balance things like this. At one point, I did have counts on the lower end while taking aspirin and my hemo wanted my counts to stay above 50k. Being on Plavix might change that goal.

I understand your concerns about Rituxan, and I would also add the possibility of heart issues while using Rituxan. Have you read the full manufacturer's insert? www.gene.com/download/pdf/rituxan_prescribing.pdf

I wouldn't worry too much about infection if the rest of your immune system is healthy and intact. Most of us did well without getting sick, although when it is the season for coughs and colds the risk is there anyway.

I'm sorry that I'm not much help. Treatment decisions are never easy ones when there are multiple problems to juggle.

My brother in law had a couple of stints put in about a year ago. I warned him ahead of time that I had heard that blood thinners, like Warfarin, can kill you and to be very careful with them. A few weeks after surgery he went to go work out with weights. It caused brain bleeding and ended up in the hospital for several days. Since then, he takes no blood thinners. Live and learn... Can't remember which blood thinner he was taking. Think he just takes aspirin now, not sure.

In my humble and non doctor opinion, what I find 'counter productive' is taking Plavix and/or Aspirin with a count of 12. I admit that I am not familiar with Plavix. Perhaps it is less dangerous than Warfarin? Aren't the purpose of blood thinners to reduce *long term* re-buildup of plaques in the stinted artery?

Did the doctor want to do stints because it was safer than artery resection with someone with ITP? Did you have to take steroids or IVIG to get your counts up for stint surgery?

Hal my understanding is warfarin counteracts vitamin k whereas Clopidogrel inhibits platelet aggregation

The thing is that both aspirin and Plavix prevent platelets from sticking together and forming clots. Low counts do not protect a person against clotting and clots can occur with a low count. However, bleeding can occur when counts are low and is a bigger risk when taking drugs that prevent clotting. It is a difficult balance so usually the best thing to do is get the platelets to a safe number, not necessarily a high or normal number.

I appreciate your insights. Many thanks.