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ITP related question
My wife has ITP. It was first detected when she was a child. After taking steroids for some days, her platelet count became normal. Then for many years everything was fine. During her teenage years, her platelets dropped again but became normal within one week.
This time, after a few years, she had another ITP episode and her platelets dropped to 30-40 thousand.
Due to heavy menstrual bleeding, she also lost blood.
The doctor gave her Wysolone and Eltrombopag.
Within 7-8 days, her platelets increased to 460,000.
My only question is: Should we continue Eltrombopag or not? Does continuing it increase the risk of clotting or blood clots? When should it be stopped, or should it be continued?
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Your wife has chronic / relapsing ITP (Immune Thrombocytopenia) — a pattern of episodes since childhood, with spontaneous remissions in between, and now a more significant drop (to 30–40,000) with heavy menstrual bleeding contributing to anemia/blood loss.
The excellent response (platelets jumped to 460,000 in just 7–8 days) on Wysolone (prednisolone) + Eltrombopag is very encouraging — this is a very good response to second-line therapy (TPO-RA = thrombopoietin receptor agonist).
Should you continue Eltrombopag?
→ Yes, continue it for now — do not stop abruptly on your own.
Why continue?
• Stopping too early (especially when platelets are still climbing or just reached normal) often causes rapid relapse in ITP (platelets can drop again within days to weeks).
• Eltrombopag helps keep platelets stable while the immune system is being calmed by steroids (and hopefully enters a longer remission).
• Current level (460,000) is actually a bit high — this is common early on with TPO-RAs (over-response), but it is not dangerous in ITP patients.
Does continuing Eltrombopag increase risk of blood clots?
→ The risk is very low in ITP patients.
• Real-world data and studies show thrombotic events (clots) occur in only ~2–6% of patients on eltrombopag (romiplostim similar), and most happen in people who already have major clot risk factors (atrial fibrillation, previous clots, cancer, very high platelets >1 million for long time, immobility).
• At 460,000, the risk is not significantly increased compared to normal people.
• Doctors usually reduce/stop the dose when platelets stay consistently >150–200–300 ×10⁹/L for several weeks.
Next Steps
• Do NOT stop Eltrombopag yourself — sudden stop can cause rebound drop in platelets (sometimes very severe).
• Contact her hematologist as soon as possible (within 1–2 weeks or sooner if platelets keep rising above 600–800k):
• Ask for a dose reduction plan (e.g., reduce eltrombopag from current dose to half or every other day) while monitoring platelets 1–2 times per week.
• Typical goal: keep platelets 50–150 ×10⁹/L (safe range — no bleeding risk, no excessive clot risk).
• Discuss steroid tapering — Wysolone should be reduced slowly (e.g., 5–10 mg every 1–2 weeks) to lowest effective dose or off completely if platelets stay stable on eltrombopag alone.
• Repeat CBC (platelet count) every 3–7 days until stable, then every 2–4 weeks.
Health Tips
• Watch for any signs of clotting (sudden leg swelling/pain, chest pain, shortness of breath, severe headache) — rare, but report immediately.
• Avoid injury / trauma while platelets are high (normal precautions).
• Continue iron + folic acid if she is anemic from heavy bleeding.
• Heavy periods: discuss tranexamic acid or hormonal options (e.g., progesterone) with gynecologist to reduce bleeding during future low-platelet episodes.
• Most patients with good response to TPO-RAs like eltrombopag can eventually reduce or stop it after 6–24 months if remission is sustained — but it is individualized.
This is a very favorable response — she is in a strong position now.
The key is gradual, doctor-guided tapering of both steroids and eltrombopag while keeping platelets in a safe range.
Please consult her hematologist soon to make the exact plan — do not adjust doses on your own.
For more help (share latest platelet count or doctor’s current dose), feel free to ask.
Wishing her continued good response and long remission
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See the thing is that the decision maker should be your treating doctor and yes your questions are correct and valid you should be asking these questions to the treating doctor rather than asking here eventually your doctor will taper down the dose or maybe completely stop he knows the patient better than us
Next Steps
keep in touch with treating physician don't get trapped in silly suggestions from the internet
Health Tips
i hope your wife gets well soon
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