Short‐ and long‐term effects of therapy with interferon‐α and pegylated interferon‐α/ribavirin on platelet plug formation and von Willebrand factor release in patients with chronic hepatitis C

Abstract

SUMMARYBackground: A pegylated interferon-alpha-induced decrease in platelet counts may become a limiting factor for continuation of therapy. Aim: To evaluate the effect of pegylated interferon-a administration on platelet plug formation and von Willebrand factor antigen release in patients with chronic hepatitis C. Methods: Thirty patients with chronic hepatitis C (genotype 1; fibrosis 1-3: n ¼ 16, cirrhosis: n ¼ 14) received a single dose of 9 MU interferon-a2a, followed by weekly administration of 180 lg of pegylated interferon-a2a/ribavirin for 48 weeks. Platelet counts, platelet function (collagen-epinephrine-induced closure time) and von Willebrand factor antigen were measured. Results: Platelet counts and collagen-epinephrine-induced closure time decreased by 13% and 16%, respectively, 24 h after the first dose of interferon-a2a, and von Willebrand factor antigen levels increased by

Von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis

“…To increase the probability of a proper testing, it is advisable that the measurement should be done at a facility with immediate on‐site processing in their own specialized coagulation laboratory,24 which is not always found in small hospitals. However, certain known limitations to the application of vWF‐Ag levels in patients with cirrhosis have to be considerd (e.g., infections, malignancies, physical training or IFN therapy),14, 15 which have been shown to elevate vWF‐Ag levels. Hereditary vWF‐Ag deficiency or acute bleeding may diminish vWF‐Ag levels and the degree of PH might be underestimated.…”

“…Liver cirrhosis was diagnosed histologically, clinically, or by typical radiological findings. Exclusion criteria were presence of pre‐ and posthepatic causes of PH, severe cardiopulmonary or renal impairment, active infections, diabetes, anticoagulant therapy, antiplatelet drugs, as well as current treatment with beta‐blockers, statins, or interferon (IFN) 14, 15. Patients with alcoholic liver disease had to be abstinent from alcohol for at least 3 months.…”

“…Plasma levels of vWF‐Ag were measured as previously described14 using a fully automated STA analyzer and vWF‐Liatest (Diagnostica Stago, Paris, France).…”

Standard interferon-alpha in combination with ribavirin for hepatitis C patients with advanced liver disease and thrombocytopenia

“…The pretreatment CTP grade was A in six patients and B in three. The MELD score was 11 [6][7][8][9][10][11][12][13][14][15][16][17] (median [range]). Three patients were infected with HCV genotype 1b, four with genotype 3a and two with genotype 4.…”

“…Laparoscopic splenectomy [11] and partial splenic embolization [10], as a less invasive approach, have been shown to reverse thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension and were used to treat thrombocytopenia prior to the start of combination treatment. The use of hematopoietic growth factors such as erythropoietin-a for maintaining the ribavirin dose might also have beneficial effects on platelet counts [12], especially as endogenous thrombopoietin levels fail to increase in IFN-induced thrombocytopenia in cirrhotic patients [13], because of altered thrombopoietin signaling [14]. In a prospective trial using IFN monotherapy in patients with cirrhosis, the frequency of thrombocytopenia was three times higher in the group receiving pegylated IFN than in those receiving standard IFN [7].…”