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Management of Adult Patients with Persistent Idiopathic Thrombocytopenic Purpura Following Splenectomy: A Systematic Review

Sara K. Vesely, PhD; Jedidiah J. Perdue, MPH; Mujahid A. Rizvi, MD, MPH; Deirdra R. Terrell, MPH; and James N. George, MD
[+] Article, Author, and Disclosure Information

From the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Grant Support: By the DAISY Foundation, Glen Ellen, California.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James N. George, MD, Hematology–Oncology Section, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190; e-mail, James-George@OUHSC.edu.

Current Author Addresses: Drs. Vesely, Terrell, and George and Mr. Perdue: Hematology-Oncology Section, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190.

Dr. Rizvi: Division of Hematology/Oncology, Northwestern University, 676 St. Claire, Chicago, IL 60611.

Ann Intern Med. 2004;140(2):112-120. doi:10.7326/0003-4819-140-3-200402030-00012
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Background: Both diabetes mellitus and alcohol consumption are prevalent in the United States, yet physicians are poorly informed about how alcohol use affects risk for or management of diabetes.

Purpose: To conduct a systematic review assessing the effect of alcohol use on the incidence, management, and complications of diabetes mellitus in adults.

Data Sources: English-language studies in persons 19 years of age or older that were identified by searching the MEDLINE database from 1966 to the third week of August 2003 and the reference lists of key articles.

Study Selection: Two independent assessors reviewed 974 retrieved citations to identify all experimental, cohort, or case–control studies that assessed the effect of alcohol use on diabetes risk, control, self-management, adverse drug events, or complications.

Data Extraction: Two independent reviewers extracted data and evaluated study quality on the basis of established criteria.

Data Synthesis: Thirty-two studies that met inclusion criteria were reviewed. Compared with no alcohol use, moderate consumption (one to 3 drinks/d) is associated with a 33% to 56% lower incidence of diabetes and a 34% to 55% lower incidence of diabetes-related coronary heart disease. Compared with moderate consumption, heavy consumption (>3 drinks/d) may be associated with up to a 43% increased incidence of diabetes. Moderate alcohol consumption does not acutely impair glycemic control in persons with diabetes.

Conclusions: Moderate alcohol consumption is associated with a decreased incidence of diabetes mellitus and a decreased incidence of heart disease in persons with diabetes. Further studies are needed to assess the long-term effects of alcohol consumption on glycemic control and noncardiac complications in persons with diabetes.


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Article and patient selection.

Articles were retrieved for review if their journal, title, or abstract suggested that they contained evaluable data on eligible patients and indicated that they did not primarily report on children. Retrieved articles were not reviewed if they were reviews or other articles with no patient data; if they did not report on a treatment of interest, defined in the Methods section as treatment with the goal of a durable remission; or if they reported fewer than 5 total patients. Reviewed articles were excluded if they did not contain eligible patients. The primary platelet count criterion for eligibility was less than 50 × 109 cells/L; patients were further separated into groups with platelet counts less than 30 × 109 cells/L and less than 10 × 109 cells/L.

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Summary for Patients

Treatment Options for Idiopathic Thrombocytopenic Purpura When Splenectomy Is Ineffective

The summary below is from the full report titled “Management of Adult Patients with Persistent Idiopathic Thrombocytopenic Purpura Following Splenectomy. A Systematic Review.” It is in the 20 January 2004 issue of Annals of Internal Medicine (volume 140, pages 112-120). The authors are S.K. Vesely, J.J. Perdue, M.A. Rizvi, D.R. Terrell, and J.N. George.


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