Immune Thrombocytopenia Patients Requiring Anticoagulation-Maneuvering Between Scylla and Charybdis

Immune thrombocytopenia (ITP) is no longer a disorder of young people. Half of the patients are older than 50 and comorbidities become more common with age. Anticoagulation has to be discussed when an ITP patient develops atrial fibrillation, venous or arterial thromboembolism, myocardial infarction, or stroke. At the same time low platelet counts often prohibit therapeutic anticoagulation. Guidelines do not give guidance for these situations. This article summarizes experiences from case reports and small series and suggests an approach to ITP patients with thrombocytopenia and an indication for anticoagulation.