Summary To investigate the risk factors, treatment strategies and prognosis in patients with acute ischaemic stroke (AIS) after immune thrombocytopenia (ITP), we conducted a multicentre case–control study. One hundred and thirteen adult ITP patients with AIS were included, and each ITP‐AIS was paired with three control subjects. The ITP‐AIS cohort had a median age of 65 (24–97) years, was predominately female (61 vs. 52) and had a median platelet count of 44 × 10 9 /L (range: 4–355 × 10 9 /L) at the time of AIS. Post‐infarction treatment included anti‐platelet therapy ( n = 36, 31.9%), anti‐coagulation therapy ( n = 4, 3.5%), combined anti‐platelet–anti‐coagulation therapy ( n = 4, 3.5%) and endovascular thrombectomy ( n = 1, 0.9%). Haemorrhagic transformation occurred in 5 (4.4%) patients. Three patients (2.7%) died due to intracranial haemorrhage, gastrointestinal haemorrhage or severe pulmonary infection. Multivariate analysis revealed that age greater than 60 years ( p < 0.001; odds ratio OR 3.12; 95% confidence interval CI 1.82–5.37), diabetes mellitus ( p = 0.018; OR 1.99; 95% CI 1.13–3.52), hypertension ( p < 0.001; OR 2.75; 95% CI 1.62–4.66), renal failure ( p = 0.036; OR 3.00; 95% CI 1.08–8.38), smoking ( p < 0.001; OR 5.02; 95% CI 2.31–10.88) and hyper‐low‐density lipoprotein (LDL)‐C ( p = 0.02; OR 2.34; 95% CI, 1.14–4.78) were independent risk factors for AIS after ITP. This study revealed that ITP‐related treatments might not increase the risk of ITP‐AIS. The management of ITP‐AIS patients requires close collaboration between haematologists and vascular neurologists to carefully balance therapeutic benefits against the risk of haemorrhagic complications.
Cao et al. (Mon,) studied this question.