Pre-operative use of romiplostim in thrombocytopenic patients with chronic hepatitis C and liver cirrhosis
Journal of Gastroenterology and Hepatology, 08/09/2012  Clinical Article

Moussa MM et al. – Pre–operative 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 hepatitis C virus (HCV) infection who are unresponsive to standard therapy.

• Romiplostim was administered at 2 μg/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 end of study, along with liver and kidney function assessments.
• A complete blood count was performed every third day throughout the study period.

• 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 18-39.
• The reticulin bone marrow grade remained negative in all patients.
• Surgical interventions were associated with no post-operative bleeding or thrombotic complications.