McMaster Textbook of Internal Medicine

McMaster Textbook of Internal Medicine
Interviews
Hematology
Prednisone vs dexamethasone as the first-line treatment of ITP

Prednisone vs dexamethasone as the first-line treatment of ITP

2018-06-26

Mark Crowther

Do you use prednisone or dexamethasone in the first-line treatment of immune thrombocytopenia (ITP)?

Mark Crowther: I use 40 mg of dexamethasone once a day for 4 days. The reason is that it gets people off the steroid much more quickly than the prednisone. They are probably equivalently effective, but if it was me, I would choose to take 4 days of very high dexamethasone rather than weeks or months of prednisone, with the risks of chronic exposure to prednisone therapy.

There is also some soft evidence based on a couple of randomized controlled trials that the high-dose dexamethasone may more favorably influence the likelihood of developing a remission from the ITP.

I routinely use dexamethasone as a first course. If the person relapses, which they frequently do, I oftentimes will use dexamethasone as a second course but sometimes I will put them on prednisone afterwards.

See also

Approach to a patient with reactive thrombocythemia What is your approach to reactive thrombocythemia? Do you use anticoagulants or aspirin?
Antithrombotic therapies: current patterns of practice and controversies A lecture by Dr Mark Crowther, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Anticoagulation following an episode of severe bleeding What patients should not be restarted on anticoagulation therapy following an episode of severe bleeding?
Popliteal vein thrombosis after a flight. Part 1 A 40-year-old otherwise healthy man had a popliteal vein thrombosis after a 9-hour flight. One month after the event there was no sign of a thrombus on ultrasonography and D-dimer levels were normal. What prophylaxis should be used in this patient before long-haul flights in the future?
Common genetic thrombophilias and hormonal contraception Is it advisable to screen patients for the most common genetic thrombophilias before starting hormonal contraception?
A practical approach to a patient with thrombocytopenia A lecture by Prof. John Kelton, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2016.

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