Recurrent Thrombosis in a Very Elderly Patient With Dementia, Atrial Fibrillation, and Idiopathic Thrombocytopenic Purpura on Eltrombopag Treatment

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder, leading to an increased bruising and bleeding tendency. Eltrombopag, a thrombopoietin receptor agonist, is an effective treatment option even in elderly patients with ITP. In this report, we present a case of recurrent thrombosis, presenting as acute myocardial infarction and cerebral infarction, in a very elderly patient with dementia, atrial fibrillation, and ITP on eltrombopag treatment. Multiple comorbidities with thrombosis and bleeding risks posed a therapeutic dilemma. Conditions unique to the elderly, such as cognitive impairment or frailty, led to a delayed diagnosis. This case gives an insight into how to manage a practical therapeutic problem in such a case. Physicians need to understand conditions unique to the elderly, such as cognitive impairment, frailty, or quality of life that influence treatment goals. These efforts can help provide health benefits while minimizing treatment risks, especially in elderly patients with multiple comorbidities.