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Symptoms remained essentially unchanged in 9 patients and became more pronounced in the posttreatment period in 4 patients. In no case was an increase in platelet counts observed. Conclusion In summary, this article describes the therapeutic options for adult patients with ITP, as outlined in Figure 1. Selecting the right treatment depends on many factors that the treating physician should be aware of, and which are summarized below: 1. Type of ITP acute vs chronic refractory ; : Whereas the treatment of acute ITP is straightforward, the treatment of refractory ITP is more challenging given that the disease is more resistant and the list of available medications is long. Our preference is to start with monoclonal antibodies, especially rituximab, before moving to other available agents. 2. Time to Response: This is especially important when a quick rise in the platelet count is needed to prevent a major complication. The agents that produce the fastest increase in platelet count are IVIG, anti-Rh D ; , and high-dose steroids. These are our drugs of choice for ITP patients who present with platelet counts less than 10, 000 L and or signs or symptoms of bleeding. 3. Adverse Events: As an example, alemtuzumab seems to have good activity in the treatment of refractory ITP; however, its toxicity profile may hinder its use. Further studies are warranted to evaluate the best mode of administration for efficacy and for toxicity reduction. 4. Cost: Cost may hinder the use of active medications with minimal toxicities, such as rituximab, as first-line treatment. 5. Response Rate: Tables 1 and 2 summarize the response rates of the drugs used in the management of ITP. Acknowledgment This work is supported by the Hope Sheridan Foundation. References, for example, prinzide.

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Stuart J. Connolly, MD Paul Dorian, MD Robin S. Roberts, MTech Michael Gent, DSc Steven Bailin, MD Eric S. Fain, MD Kevin Thorpe, PhD Jean Champagne, MD Mario Talajic, MD Benoit Coutu, MD Gerian C. Gronefeld, MD Stefan H. Hohnloser, MD for the Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients OPTIC ; Investigators.

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For information in cases of overdose or unintentional ingestion, contact the american society for the prevention of cruelty to animals aspca ; national animal poison control center 888-426-4435 or 900-443-000; a fee may be required for consultation ; and or the drug manufacturer.
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TABLE 1. Characteristics of patientsa.

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