{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T10:15:46Z","timestamp":1767176146425,"version":"build-2238731810"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Thrombosis J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Thrombosis in patients with thrombocytopenia has several risk factors, both disease-related and treatment-associated. Recently, COVID-19 infection was recognized as an additional risk factor, further complicating the delicate balance between thrombosis and bleeding in these patients. Here we describe the case of a patient with aplastic anaemia on eltrombopag who developed pulmonary embolism during COVID-19 pneumonia, despite receiving oral anticoagulation with edoxaban. Notably, he was also carrying a large paroxysmal nocturnal haemoglobinuria clone, although without evidence of haemolysis. The presented case recapitulates some of the open questions in thrombotic risk management of cytopenic patients, such as the management of thrombopoietin receptor agonists and the choice of anticoagulation in PNH, while also accounting for the additional thrombotic risk linked to COVID-19.<\/jats:p>","DOI":"10.1186\/s12959-022-00407-w","type":"journal-article","created":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T19:03:32Z","timestamp":1661281412000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Pulmonary embolism in a patient with eltrombopag-treated aplastic anaemia and paroxysmal nocturnal haemoglobinuria clone during COVID-19 pneumonia"],"prefix":"10.1186","volume":"20","author":[{"given":"Alessandro","family":"Bosi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilma","family":"Barcellini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Fattizzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"407_CR1","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.ejim.2020.09.006","volume":"82","author":"L Roncon","year":"2020","unstructured":"Roncon L, Zuin M, Barco S, Valerio L, Zuliani G, Zonzin P, et al. Incidence of acute pulmonary embolism in COVID-19 patients: systematic review and meta-analysis. Eur J Int Med. 2020;82:29\u201337.","journal-title":"Eur J Int Med"},{"issue":"7","key":"407_CR2","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1002\/rth2.12439","volume":"4","author":"S Nopp","year":"2020","unstructured":"Nopp S, Moik F, Jilma B, Pabinger I, Ay C. Risk of venous thromboembolism in patients with COVID-19: a systematic review and meta-analysis. Res Pract Thrombosis Haemostasis. 2020;4(7):1178\u201391.","journal-title":"Res Pract Thrombosis Haemostasis"},{"key":"407_CR3","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.thromres.2020.04.013","volume":"191","author":"FA Klok","year":"2020","unstructured":"Klok FA, Kruip MJ, Van der Meer NJ, Arbous MS, Gommers DA, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145\u20137.","journal-title":"Thromb Res"},{"issue":"3","key":"407_CR4","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/ejh.12543","volume":"95","author":"B Devalet","year":"2015","unstructured":"Devalet B, Mullier F, Chatelain B, Dogn\u00e9 JM, Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review. Eur J Haematol. 2015;95(3):190\u20138.","journal-title":"Eur J Haematol"},{"issue":"22","key":"407_CR5","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1182\/blood.V128.22.1368.1368","volume":"128","author":"MN Saleh","year":"2016","unstructured":"Saleh MN, Bussel JB, Wong RS, Meddeb B, Salama A, El-Ali A, et al. Hepatobiliary and thromboembolic events during long-term EXTEN Ded treatment with eltrombopag in adult patients with chronic immune thrombocytopenia (ITP). Blood. 2016;128(22):1368.","journal-title":"Blood."},{"issue":"23","key":"407_CR6","doi-asserted-by":"publisher","first-page":"3829","DOI":"10.1182\/bloodadvances.2019000966","volume":"3","author":"C Neunert","year":"2019","unstructured":"Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood advances. 2019;3(23):3829\u201366.","journal-title":"Blood advances"},{"issue":"6","key":"407_CR7","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1111\/bjh.16775","volume":"189","author":"S Pavord","year":"2020","unstructured":"Pavord S, Thachil J, Hunt BJ, Murphy M, Lowe G, Laffan M, et al. Practical guidance for the management of adults with immune thrombocytopenia during the COVID-19 pandemic. Br J Haematol. 2020;189(6):1038\u201343. https:\/\/doi.org\/10.1111\/bjh.16775 Epub 2020 Jun 2. PMID: 32374026; PMCID: PMC7267627.","journal-title":"Br J Haematol"},{"key":"407_CR8","doi-asserted-by":"crossref","unstructured":"Rodeghiero F, Cantoni S, Carli G, Carpenedo M, Carrai V, Chiurazzi F, De Stefano V, Santoro C, Siragusa S, Zaja F, Vianelli N. Practical recommendations for the management of patients with ITP during the COVID-19 pandemic. Mediterranean journal of hematology and infectious diseases. 2021;13(1).","DOI":"10.4084\/MJHID.2021.032"},{"issue":"25","key":"407_CR9","doi-asserted-by":"publisher","first-page":"4985","DOI":"10.1182\/blood-2012-09-311381","volume":"121","author":"A Hill","year":"2013","unstructured":"Hill A, Kelly RJ, Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria. Blood. 2013;121(25):4985\u201396.","journal-title":"Blood"},{"issue":"3","key":"407_CR10","first-page":"124","volume":"55","author":"FS de Fontbrune","year":"2018","unstructured":"de Fontbrune FS, de Latour RP. Ten years of clinical experience with eculizumab in patients with paroxysmal nocturnal hemoglobinuria. InSeminars Hematol. 2018;55(3):124\u20139 WB Saunders.","journal-title":"InSeminars Hematol"},{"issue":"10","key":"407_CR11","doi-asserted-by":"publisher","first-page":"3587","DOI":"10.1182\/blood-2003-01-0009","volume":"102","author":"C Hall","year":"2003","unstructured":"Hall C, Richards S, Hillmen P. Primary prophylaxis with warfarin prevents thrombosis in paroxysmal nocturnal hemoglobinuria (PNH). Blood. 2003;102(10):3587\u201391.","journal-title":"Blood."},{"issue":"12","key":"407_CR12","doi-asserted-by":"publisher","first-page":"3699","DOI":"10.1182\/blood-2005-04-1717","volume":"106","author":"C Parker","year":"2005","unstructured":"Parker C, Omine M, Richards S, Nishimura JI, Bessler M, Ware R, et al. Diagnosis and management of paroxysmal nocturnal hemoglobinuria. 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Rivaroxaban versus vitamin K antagonist in antiphospholipid syndrome: a randomized noninferiority trial. Ann Intern Med. 2019;171(10):685\u201394.","journal-title":"Ann Intern Med"}],"updated-by":[{"DOI":"10.1186\/s12959-022-00412-z","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000}}],"container-title":["Thrombosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12959-022-00407-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12959-022-00407-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12959-022-00407-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T06:23:15Z","timestamp":1663050195000},"score":1,"resource":{"primary":{"URL":"https:\/\/thrombosisjournal.biomedcentral.com\/articles\/10.1186\/s12959-022-00407-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,24]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["407"],"URL":"https:\/\/doi.org\/10.1186\/s12959-022-00407-w","relation":{},"ISSN":["1477-9560"],"issn-type":[{"value":"1477-9560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,24]]},"assertion":[{"value":"2 June 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 July 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2022","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1186\/s12959-022-00412-z","URL":"https:\/\/doi.org\/10.1186\/s12959-022-00412-z","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patient gave his consent for pubblication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interest inherent to the present article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"46"}}