Ischemic stroke/transient ischemic attack in adults with primary immune thrombocytopenia: a meta-analysis

Objective To carry out a systematic review to help resolve the controversy of ischemic stroke (IS)/transient ischemic attack (TIA) in patients with primary immune thrombocytopenia (ITP). Methods A database search of PubMed and Ovid Embase was conducted for epidemiologic studies published up to December 17, 2019. The effective size was estimated by pooled prevalence, annualized incidence/risk, relative risk (RR), and their corresponding 95% confidence intervals (CIs). Results The systematic review included 14 eligible studies from 11 publications. The pooled annualized cumulative incidence was 0.15% (95% CI, 0.03–0.26%) per person-years. And the pooled annualized cumulative risk of IS/TIA of ITP was 0.86% (95% CI, 0.33–1.39%) per year based on 3 population-based cohort studies. There was a higher risk of incident IS/TIA in ITP patients than ITP-free subjects (pooled unadjusted or adjusted RR with 95% CI, 1.46 [1.22–1.74] or 1.50 [1.29–1.73]). Conclusions IS/TIA was not uncommon in patients with primary ITP. ITP patients have a higher risk of IS/TIA compared with the reference cohorts. Healthcare professionals should take into account the risk of IS/TIA when treating ITP patients with or without a history of IS/TIA.