When to Initiate Treatment for ITP

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The goal of idiopathic thrombocytopenic purpura (ITP) treatment, explains Ivy Altomare, MD, is to treat active bleeding or reduce the risk of bleeding. Determining when to treat a patient with ITP depends on several factors, says Howard A. Liebman, MD, including patient preference and clinical manifestations.

The majority opinion is that patients should consider treatment, if they are not bleeding, only when platelet counts are less than 30,000. Keith McCrae, MD, states that a sedentary person’s platelet count can go quite low, perhaps even below 20,000, before therapy is required. Individuals with a platelet count around 30,000 do not usually have clinically significant bleeding that would put them at risk.

It is also important to consider patient characteristics, such as age and comorbidities, Altomare notes. Older individuals with coronary artery disease taking antiplatelet therapy may be at higher risk of bleeding.