Other Treatments
Some treatments for ITP don’t fit neatly into the main categories of corticosteroids, IVIg, TPO-RAs or immunosuppressants. These “other treatments” support platelet levels, reduce bleeding, or are used when other treatments are not suitable or have not worked well enough.
Treatments included
Procedures
- Splenectomy
Supportive treatments
- Tranexamic acid (TXA)
- Hormonal therapies (e.g., for heavy menstrual bleeding)
- Natural therapies (with safety considerations)
Emerging treatments (not available in Australia)
- Fostamatinib (SYK inhibitor)
- Rilzabrutinib (BTK inhibitor)
- Efgartigimod (FcRn blocker)
Splenectomy
When splenectomy is used
Splenectomy is usually considered when:
- ITP has lasted more than 12 months
- Other treatments have not worked well enough
- A person prefers a potential long-term solution
- TPO-RAs or immunosuppressants are not suitable
It is rarely used in children and generally avoided in the first year after diagnosis
How it works
The spleen is a major site where antibody-coated platelets are destroyed. Removing it:
- Reduces platelet destruction
- Can lead to long-term remission in 60–70% of adults
What to expect
- Usually performed laparoscopically (keyhole surgery)
- Short hospital stay
- Platelet counts often rise quickly
- Some people may still need treatment afterwards
Side effects
- Increased lifelong risk of certain infections
- Possible increased risk of blood clots
- Vaccinations required before and after surgery
Adults, Children and Pregnancy
- Adults: May be considered after 12 months of persistent ITP
- Children: Rarely recommended
- Pregnancy: Usually avoided
Tranexamic Acid (TXA)
When TXA used
- Nosebleeds
- Mouth bleeding
- Heavy menstrual bleeding
- Dental procedures
- As a supportive treatment alongside other ITP therapy
How it works
TXA helps stabilise blood clots by preventing them from breaking down too quickly.
What to expect
- Taken as tablets or liquid
- Can be used short-term or as needed
- Often used with other ITP treatments
Side effects
- Nausea
- Stomach upset
- Rarely, increased risk of clotting
Adults, Children and Pregnancy
- Safe for adults and children
- Commonly used for heavy periods
- May be used in pregnancy under medical guidance
Hormonal Therapies
When hormonal therapies are used
- Heavy or prolonged menstrual bleeding
- When bleeding affects quality of life
- When platelet counts are low and periods become difficult to manage
How they work
Hormonal therapies stabilise the lining of the uterus and reduce menstrual flow.
What to expect
Options may include:
- Combined oral contraceptive pill
- Progesterone-only pill
- Hormonal IUD (e.g., Mirena)
- Injectable or implantable hormones
Side effects
Side effects depend on the specific therapy and may include mood changes, spotting, or breast tenderness.
Adults, Children and Pregnancy
- Used in teens and adults
- Not used during pregnancy
- Helpful for people with heavy periods and low platelets
Natural Therapies
When natural therapies are used
- To support overall health
- To manage stress or fatigue
- As complementary care alongside medical treatment
How they work
Natural therapies vary widely and may include:
- Diet and nutrition
- Gentle exercise
- Mind-body therapies (yoga, meditation)
- Supplements (with caution)
What to expect
Options may include:
- Natural therapies should never replace medical treatment
- Some supplements (e.g., turmeric, fish oil, ginkgo) can increase bleeding risk
- Always discuss supplements with your doctor
Side effects
Side effects depend on the specific therapy and may include mood changes, spotting, or breast tenderness
Adults, Children and Pregnancy
- Safe options vary by age
- Supplements should be used cautiously in pregnancy
- Always check with your healthcare team
Emerging Treatments
These treatments are not currently available in Australia or New Zealand; however, they are available in other locations, including the USA, UK and Europe.
Fostamatinib (SYK inhibitor)
SYK inhibitors block a protein called spleen tyrosine kinase (SYK), which plays a key role in the immune system’s process of destroying platelets. By blocking SYK, these medicines help reduce the immune attack on platelets, allowing platelet counts to rise.
Why it matters in ITP
In ITP, immune cells attach to platelets and mark them for destruction. SYK is one of the main signals that tells the body to remove those platelets. Blocking SYK interrupts this process.
Availability
- Also known as Tavalisse
- Used in chronic ITP overseas
Rilzabrutinib (BTK inhibitor)
BTK inhibitors block Bruton’s tyrosine kinase (BTK), a protein involved in activating immune cells that produce antibodies. By reducing this activity, BTK inhibitors help lower the immune response that leads to platelet destruction.
Why it matters in ITP
BTK is part of the signalling pathway that helps B-cells make antibodies. In ITP, these antibodies attach to platelets, so reducing BTK activity may reduce platelet destruction.
Availability
- Also known as Wayrilz
- Used in chronic ITP overseas
Efgartigimod (FcRn blocker)
FcRn blockers target the neonatal Fc receptor (FcRn) — a protein that normally protects IgG antibodies from being broken down. By blocking FcRn, these medicines help the body remove IgG antibodies more quickly.
Why it matters in ITP
In many people with ITP, IgG antibodies attach to platelets and mark them for destruction. Lowering IgG levels can reduce this process and help platelet counts rise.
Availability
- Also known as Vyvgart
- Used in chronic ITP overseas