Abstract
In patients with immune thrombocytopenia (ITP) refractory to corticosteroids and intravenous immunoglobulins (IVIG), splenectomy may result at higher risk of peri-operative complications and, for this reason, potentially contraindicated. The thrombopoietin receptor agonists (TPO-RAs) romiplostim and eltrombopag have shown high therapeutic activity in primary ITP, but data of efficacy and safety regarding their use in preparation for splenectomy are missing. Thirty-one adult patients, median age 50 years, with corticosteroids and/or IVIG refractory persistent and chronic ITP who were treated with TPO-RAs (romiplostim= 24; eltrombopag= 7) with the aim to increase platelet count and allow a safer execution of splenectomy were retrospectively evaluated. Twenty-four patients (77%) responded to the use of TPO-RAs with a median platelet count that increased from 11 × 10(9) /L before starting TPO-RAs to 114 × 10(9) /L pre-splenectomy, but a concomitant treatment with corticosteroids and/or IVIG was required in 19 patients. Twenty-nine patients underwent splenectomy while two patients who responded to TPO-RAs subsequently refused surgery. Post-splenectomy complications were characterized by two Grade 3 thrombotic events (1 portal vein thrombosis in the patient with previous history of HCV hepatitis and 1 pulmonary embolism), with a platelet count at the time of thrombosis of 260 and 167 × 10(9) /L, respectively and one Grade 3 infectious event. TPO-RAs may represent a therapeutic option to improve platelet count and reduce the risk of peri-operative complications in ITP candidates to splenectomy. An increased risk of post-splenectomy thromboembolic events cannot be ruled out and thromboprophylaxis with low-molecular weight heparin is generally recommended.
© 2016 Wiley Periodicals, Inc.
Publication types
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Multicenter Study
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Observational Study
MeSH terms
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Adrenal Cortex Hormones / pharmacology
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Adrenal Cortex Hormones / therapeutic use
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Adult
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Aged
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Aged, 80 and over
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Benzoates / administration & dosage
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Benzoates / adverse effects
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Benzoates / therapeutic use*
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Combined Modality Therapy
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Drug Resistance
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Female
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Humans
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Hydrazines / administration & dosage
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Hydrazines / adverse effects
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Hydrazines / therapeutic use*
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Immunoglobulins, Intravenous / pharmacology
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Immunoglobulins, Intravenous / therapeutic use
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Italy / epidemiology
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Male
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Middle Aged
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Platelet Count
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Portal Vein
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Postoperative Complications / chemically induced
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Postoperative Complications / etiology
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Postoperative Complications / prevention & control
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Premedication*
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Preoperative Care / methods*
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Pulmonary Embolism / chemically induced
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Pulmonary Embolism / etiology
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Pulmonary Embolism / prevention & control
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Purpura, Thrombocytopenic, Idiopathic / drug therapy
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Purpura, Thrombocytopenic, Idiopathic / surgery*
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Pyrazoles / administration & dosage
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Pyrazoles / adverse effects
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Pyrazoles / therapeutic use*
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Receptors, Fc / administration & dosage
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Receptors, Fc / therapeutic use*
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Receptors, Thrombopoietin / agonists*
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Recombinant Fusion Proteins / administration & dosage
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Recombinant Fusion Proteins / adverse effects
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Recombinant Fusion Proteins / therapeutic use*
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Retrospective Studies
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Salvage Therapy
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Splenectomy*
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Thrombophilia / chemically induced
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Thrombopoiesis / drug effects*
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Thrombopoietin / administration & dosage
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Thrombopoietin / adverse effects
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Thrombopoietin / therapeutic use*
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Venous Thrombosis / chemically induced
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Venous Thrombosis / etiology
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Venous Thrombosis / prevention & control
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Young Adult
Substances
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Adrenal Cortex Hormones
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Benzoates
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Hydrazines
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Immunoglobulins, Intravenous
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Pyrazoles
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Receptors, Fc
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Receptors, Thrombopoietin
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Recombinant Fusion Proteins
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MPL protein, human
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Thrombopoietin
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romiplostim
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eltrombopag