Portal vein thrombosis as complication of romiplostim treatment in a cirrhotic patient with hepatitis C-associated immune thrombocytopenic purpura

Background & Aims: Thrombopoietin receptor agonists are a new class of compounds licenced for the treatment of immune thrombocytopenic purpura. They are currently being studied for patients with thrombopenia in advanced 
Background & Aims: Thrombopoietin receptor agonists are a new class of compounds licenced for the treatment of immune thrombocytopenic purpura. They are currently being studied for patients with thrombopenia in advanced liver disease or under therapy for hepatitis C. There are indications that the risk for development of portal vein thrombosis in patients with advanced liver cirrhosis might be increased under therapy with thrombopoietin receptor agonists. We report a case of a patient with Child class B liver cirrhosis with concurrent immune thrombocytopenic purpura that developed portal vein thrombosis under therapy with the thrombopoietin receptor agonist romiplostim.
Methods: A 50-year-old woman with hepatitis C virus associated immune thrombocytopenic purpura and Child class B liver cirrhosis presented in our emergency with rapidly evolving hydropic decompensation and general malaise. For immune thrombocytopenic purpura, the patient was started on the thrombopoietin receptor agonist romiplostim nine months ago.
Results: During hospitalization, the platelet count was measured above 330,000/μl and partial portal vein thrombosis was diagnosed by imaging studies. The thrombotic event was assumed to be associated with the romiplostim treatment for immune thrombocytopenic purpura via excessive elevation of platelet count. After anticoagulation with heparin and cessation of romiplostim treatment, complete recanalisation of the portal vein was achieved.
Conclusions: We conclude that romiplostim should be used with precaution in patients with hepatitis C-associated immune thrombocytopenic purpura and advanced liver cirrhosis as the risk for thrombotic complications may increase significantly.
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Author:Georg Dultz, Bernd Kronenberger, Alireza Azizi, Ulrike Mihm, Thomas J. Vogl, Ulrike Sarrazin, Christoph Sarrazin, Stefan Zeuzem, Wolf-Peter Hofmann
URN:urn:nbn:de:hebis:30:3-455587
DOI:http://dx.doi.org/10.1016/j.jhep.2011.01.020
ISSN:1600-0641
ISSN:0168-8278
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=21310200
Parent Title (English):Journal of hepatology
Publisher:Elsevier Science ; Wiley-Blackwell
Place of publication:Amsterdam [u. a.] ; [s. l.]
Document Type:Article
Language:English
Year of Completion:2011
Date of first Publication:2011/02/08
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2018/02/01
Volume:55
Issue:1
Pagenumber:4
First Page:229
Last Page:232
Note:
Under a Creative Commons license
HeBIS PPN:427970776
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0

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