{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T10:05:33Z","timestamp":1764151533810,"version":"3.46.0"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by platelet destruction. While most patients respond to first\u2010 or second\u2010line therapies, a small subset is multirefractory.\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.guidetopharmacology.org\/GRAC\/LigandDisplayForward?ligandId=7796\">Fostamatinib<\/jats:ext-link>\n                    , an oral spleen tyrosine kinase (\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.guidetopharmacology.org\/GRAC\/ObjectDisplayForward?objectId=2230\">SYK<\/jats:ext-link>\n                    ) inhibitor, is a therapeutic option in these cases. We report a case of an acute aortic dissection (AAD) occurring in a patient without traditional cardiovascular risk factors, 3\u2009months after fostamatinib initiation. A 70\u2010year\u2010old woman with a 30\u2010year history of ITP, unresponsive to multiple therapies, was treated with fostamatinib and achieved a complete haematologic response. She presented with sudden chest pain and was diagnosed with Stanford A (DeBakey type 1) AAD requiring emergency surgery. Histological analysis of her aortic tissue showed a 25% reduction in phosphorylated SYK expression compared to a control sample, without alteration in smooth muscle cell markers. The absence of predisposing conditions (hypertension, smoking, genetic disorders) led us to explore a potential link between fostamatinib and AAD. Experimental data suggest that SYK inhibition exacerbates aortic wall vulnerability, and off\u2010target effects of fostamatinib on VEGF receptors may further weaken vascular integrity. This case highlights a possible association between fostamatinib and AAD, potentially mediated by SYK and\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.guidetopharmacology.org\/GRAC\/FamilyDisplayForward?familyId=324\">VEGFR<\/jats:ext-link>\n                    inhibition. While causality cannot be definitively established, clinicians should be vigilant when prescribing fostamatinib, even in patients without known risk factors for AAD. Further studies are needed to clarify the vascular safety profile of fostamatinib in ITP and other settings.\n                  <\/jats:p>","DOI":"10.1002\/bcp.70289","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T02:22:53Z","timestamp":1758162173000},"page":"3537-3541","source":"Crossref","is-referenced-by-count":0,"title":["Fostamatinib and the risk of acute aortic dissection in immune thrombocytopenia"],"prefix":"10.1002","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7078-1880","authenticated-orcid":false,"given":"Paul","family":"Dalmas","sequence":"first","affiliation":[{"name":"Aix Marseille University, APHM, Internal Medicine Department La Timone Hospital  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Theron","sequence":"additional","affiliation":[{"name":"Department of cardiac Surgery La Timone Hospital  Marseille France"},{"name":"Aix\u2010Marseille University, INSERM MMG U1251  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Badaoui","sequence":"additional","affiliation":[{"name":"Department of cardiac Surgery La Timone Hospital  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"St\u00e9phane","family":"Zaffran","sequence":"additional","affiliation":[{"name":"Aix\u2010Marseille University, INSERM MMG U1251  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rayid","family":"Mchinda","sequence":"additional","affiliation":[{"name":"Radiology Department La Timone Hospital, Assistance Publique Des H\u00f4pitaux de Marseille  Marseille 05 France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7172-7835","authenticated-orcid":false,"given":"Joelle","family":"Micallef","sequence":"additional","affiliation":[{"name":"Aix Marseille University, APHM, Pharmacologie Clinique &amp; Pharmacosurveillance Department Sainte Marguerite Hospital and Regional Pharmacovigilance Center  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Schleinitz","sequence":"additional","affiliation":[{"name":"Aix Marseille University, APHM, Internal Medicine Department La Timone Hospital  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael","family":"Ebbo","sequence":"additional","affiliation":[{"name":"Aix Marseille University, APHM, Internal Medicine Department La Timone Hospital  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102008\u201007\u2010162503"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000966"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102022\u2010157723"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25125"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024024250"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.53"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.45977"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X16666201014142930"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537104.2022.2131751"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/prp2.175"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/ehaa946.2312"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/circ.148.suppl_1.16322"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2010.09.007"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/8321400"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.16176"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.16181"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.16180"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bcp.70289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T09:30:30Z","timestamp":1764149430000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1002\/bcp.70289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":17,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/bcp.70289"],"URL":"https:\/\/doi.org\/10.1002\/bcp.70289","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"type":"print","value":"0306-5251"},{"type":"electronic","value":"1365-2125"}],"subject":[],"published":{"date-parts":[[2025,9,17]]}}}