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

Abstract

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.

Hybrid training of voluntary and electrical muscle contractions reduces steatosis, insulin resistance, and IL-6 levels in patients with NAFLD: a pilot study

“…Blood glucose, hemoglobin A1c, serum aspartate aminotransferase (AST), ALT, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), albumin, total bilirubin, total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglyceride, insulin, blood urea nitrogen (BUN), creatinine, and creatine kinase (CK) levels were measured using standard clinical methods (Department of Clinical Laboratory, Kurume University Hospital) as previously described [42][43][44]. Insulin resistance and beta-cell function were calculated on the basis of fasting levels of plasma glucose and insulin, according to the homeostasis model assessment (HOMA) method [45].…”

Effect of three or more treatments with lusutrombopag in patients with cirrhotic thrombocytopenia: A retrospective single‐center study

“…4,5 The frequency of splenectomies and platelet transfusions is significantly higher in patients with hepatocellular carcinoma (HCC) and severe thrombocytopenia (<50000/μL) than in those without thrombocytopenia. 6 Lusutrombopag is an oral TPO receptor agonist that stimulates thrombopoiesis. The safety and efficacy of lusutrombopag in Japanese patients with thrombocytopenia associated with CLD have been reported in a previous study.…”

Efficacy and safety of eltrombopag in Japanese patients with chronic liver disease and thrombocytopenia: a randomized, open-label, phase II study

“…Thrombocytopenia often interferes with such invasive procedures and platelet transfusions may be required [4–9]. The frequency of splenectomy and platelet transfusions is significantly higher in HCC patients with severe thrombocytopenia (<50,000/μL) than in those without thrombocytopenia [10]. However, both splenectomy and platelet transfusions have limitations and disadvantages; for example, splenectomy is invasive and may be associated with life-threatening short- as well as long-term complications, and platelet transfusions are short-acting and may cause transfusion-related complications [11–14].…”