Partial splenic embolization prior to combination therapy of interferon and ribavirin in chronic hepatitis C patients with thrombocytopenia

Miyake, Yasuhiro; Ando, Masaharu; Kaji, Eisuke; Toyokawa, Tatsuya; Nakatsu, Morihito; Hirohata, Mamoru

doi:10.1111/j.1872-034x.2008.00357.x

Cited by 35 publications

(45 citation statements)

References 25 publications

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“…To date, several papers on the efficacy of PSE prior to starting interferon therapy have been already reported (12)(13)(14)(15)(16). First, Moreno et al (12,13) reported the usefulness of PSE prior to starting the combined therapy with peginterferon and ribavirin in HCV cirrhotic patients with thrombocytopenia; however, their reports were one-arm studies and did not have a non-PSE group.…”

Section: Discussionmentioning

confidence: 99%

“…First, Moreno et al (12,13) reported the usefulness of PSE prior to starting the combined therapy with peginterferon and ribavirin in HCV cirrhotic patients with thrombocytopenia; however, their reports were one-arm studies and did not have a non-PSE group. Furthermore, although the currently recommended therapy of chronic HCV infection is the combination of peginterferon and ribavirin (5), the study population of other 2 reports mainly consisted of patients treated with conventional interferon or consensus interferon (14,15). Thus, until recently, few comparative studies of the efficacy of PSE prior to starting the combined therapy with peginterferon and ribavirin in chronic hepatitis C patients with thrombocytopenia have been reported.…”

Section: Discussionmentioning

confidence: 99%

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Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

et al. 2011

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Objective Platelet counts before starting the treatment affect the discontinuation and dose reduction of peginterferon in chronic hepatitis C. Thrombocytopenia leads to failure to achieve sustained virological response. This study was undertaken to evaluate the efficacy of partial splenic embolization (PSE) prior to starting peginterferon therapy combined with ribavirin in chronic hepatitis C patients showing thrombocytopenia. Patients and MethodsWe compared the clinical features of 11 patients receiving PSE (PSE group) prior to starting the combined therapy with those of 13 patients not receiving PSE (non-PSE group). All of the patients showed platelet counts !12×10 4 /mm 3 and serum hepatitis C virus-RNA levels "100 KIU/mL at baseline. The end-point of PSE was a volume of splenic infarction over 75%. Peginterferon alpha-2b at a dose of 1.2 μg/kg was administered by subcutaneous injection once a week. The dose of ribavirin was weight adjusted. Results PSE was successfully performed without serious adverse events. The period from PSE to starting the combined therapy was 14 (6-27) days. After PSE, platelet counts were significantly increased. In PSE group, platelet counts during the combined therapy were maintained above those at baseline. In non-PSE group, platelet counts at the 2nd week after the start of the combined therapy significantly decreased to less than those at baseline. Overall, 80% adherence to expected peginterferon dose was not achieved in 5 patients (45%) of PSE group and in 11 (85%) of non-PSE group (p=0.043). Conclusion Increased platelet counts after PSE facilitates the adherence to peginterferon therapy in chronic hepatitis C patients with thrombocytopenia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

et al. 2011

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“…Therefore, we have a relatively high proportion of severe end stage patients desiring intensive care. Although splenectomy and arterial splenic embolization are efficient methods for treating HCC patients with severe thrombocytopenia [7][8][9][10], these treatment options are not always available for patients with advanced liver cirrhosis. Thus, severe thrombocytopenia is still a major unresolved issue affecting HCC treatment, and eltrombopag, a thrombopoietin-receptor agonist, is expected to improve HCC treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, thrombocytopenia is an important factor that can interfere with clinical treatments in patients with chronic liver diseases. Splenectomy or partial splenic embolization is generally considered an effective therapeutic approach for thrombocytopenia [7][8][9][10]. However, these therapeutic procedures are invasive and are not always an option for patients with advanced chronic liver diseases like liver cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia, an Important Interfering Factor of Antiviral Therapy and Hepatocellular Carcinoma Treatment for Chronic Liver Diseases

et al. 2009

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Summary:In patients with chronic liver diseases, thrombocytopenia is a common manifestation which interferes with antiviral therapy for hepatitis C virus (HCV), and with hepatocellular carcinoma (HCC) treatment. While thrombopoietin-receptor agonist is expected to improve thrombocytopenia for patients with chronic liver diseases in 2-3 weeks, there is still a lack of fundamental data about short-term variations in the natural course of platelet count in cirrhotic patients, and the impact of thrombocytopenia on antiviral therapy for HCV-infected patients and patients being treated for HCC. The aims of this study are to investigate sequential changes in platelet count and the impact of thrombocytopenia on antiviral therapy and HCC treatment in patients with chronic liver diseases. A total of 726 chronic liver disease patients were enrolled in this study. Changes of platelet count were examined during a 4-week follow-up. Risk of discontinuation or reduction of peginterferon dosage was evaluated in HCV patients with moderate thrombocytopenia (5-10×10 4 /μL). Risk of platelet transfusion or splenectomy was evaluated in HCC patients with severe thrombocytopenia (<5×10 4 /μL). No significant changes of platelet count were observed in cirrhotic patients with thrombocytopenia during a 4-week follow-up. The rate of discontinuation or reduction in dosage of peginterferon was 85.2% (23/27) in patients with moderate thrombocytopenia. Risk of discontinuation or reduction of peginterferon dosage was 3.4-times higher in HCV patients with thrombocytopenia than in those without thrombocytopenia. In HCC patients with severe thrombocytopenia, the frequency of platelet transfusion or splenectomy during HCC treatment was 57.9% (22/38). Risk of platelet transfusion or splenectomy in HCC patients with thrombocytopenia was 57.9-times higher than in those without thrombocytopenia. In conclusion, we demonstrated no significant variation in the short-term natural course of platelet count in cirrhotic patients. In chronic liver disease patients with moderate and severe thrombocytopenia, about 85% of patients treated with peginterferon, and 60% of patients receiving HCC treatments suffered from thrombocytopenia-related limitations, respectively.

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“…After PSE, the blood flow of the splenic vein decreases because of a decrease of the blood flow of the splenic artery ; thus, portal hypertension is improved by this procedure. There have been recent reports of PSE performed for pancytopenia prior to hepatocellular carcinoma treatment and interferon therapy for hepatitis C virus infection 11,12) . However, platelet transfusions are often required prior to PSE, as patients with CLD often develop thrombocytopenia due to hypersplenism.…”

Section: Casementioning

confidence: 99%

Two cases of liver cirrhosis treated with lusutrombopag before partial splenic embolization

Fujita

Abe

Hayashi

et al. 2017

FJMS

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Lusutrombopag, a small molecule thrombopoietin receptor agonist, has been approved for the treatment of chronic liver disease -associated thrombocytopenia due to hypersplenism in patients scheduled to undergo elective invasive procedures in Japan. We performed partial splenic embolization (PSE) after administration of lusutrombopag in two patients with thrombocytopenia due to cirrhosis. Case 1 involved a 50 -year -old man who developed cirrhosis due to hepatitis B virus (HBV) infection and alcohol consumption. Case 2 involved a 30 -year -old woman who developed cirrhosis due to HBV infection only. Lusutrombopag administration led to an increase in platelet count in both patients, and PSE was performed safely. However, in Case 2, the patient developed disseminated intravascular coagulation. Further study with a larger population is required to investigate the indications for and risks of the use of lusutrombopag.

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Partial splenic embolization prior to combination therapy of interferon and ribavirin in chronic hepatitis C patients with thrombocytopenia

Abstract: The increase of platelet counts after PSE may allow the safe use of IFN and RBV and improve the SVR rate in chronic hepatitis C patients with thrombocytopenia.

Cited by 35 publications

References 25 publications

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

Thrombocytopenia, an Important Interfering Factor of Antiviral Therapy and Hepatocellular Carcinoma Treatment for Chronic Liver Diseases

Two cases of liver cirrhosis treated with lusutrombopag before partial splenic embolization

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