Preoperative use of romiplostim in thrombocytopenic patients with chronic hepatitis C and liver cirrhosis

Background and Aim: Patients infected with hepatitis C virus (HCV) often develop chronic liver disease, liver cirrhosis and concurrent thrombocytopenia, which manifests as decreased platelet counts and bleeding complications. Romiplostim, a thrombopoietin mimetic peptibody that stimulates the thrombopoietin receptor, has been used as a treatment for primary immune thrombocytopenia. We monitored the efficacy of preoperative romiplostim over 90 days in 35 male patients with chronic hepatitis C, liver cirrhosis and thrombocytopenia secondary to HCV infection. Methods: Romiplostim was administered at 2μg/kg Q1W for a maximum of one month with a target platelet count of 70×109/L as a prerequisite for planned surgeries. Bone marrow aspirate was collected at baseline and at the end of the study, along with liver and kidney function assessments. A complete blood count was performed every third day throughout the study period. Results: A rapid response to romiplostim therapy was observed, with 33/35 patients achieving platelet counts≥70×109/L and thereby eligible for surgery. An initial mean platelet count of 31×109/L increased to a maximum peak range of 73-240×109/L, occurring between days 18 and 39. The reticulin bone marrow grade remained negative in all patients. Surgical interventions were associated with no postoperative bleeding or thrombotic complications. Conclusions: Preoperative romiplostim administration may represent a viable alternative to increase platelet counts to a level acceptable for elective surgical interventions in patients with chronic liver disease and severe thrombocytopenia secondary to HCV infection who are unresponsive to standard therapy. Further studies in larger numbers of patients and over a longer period of time are warranted. © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.