Thrombocytopenia and the risk of bleeding during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.

June 27, 2010

J Hepatol. 2010 Jun 1. [Epub ahead of print]

Thrombocytopenia and the risk of bleeding during treatment with peginterferon

alfa and ribavirin for chronic hepatitis C.

Roomer R, Hansen BE, Janssen HL, de Knegt RJ.

Department of Gastroenterology and Hepatology, Erasmus MC University Medical

Center Rotterdam, Rotterdam, The Netherlands.

Abstract

BACKGROUND & AIMS: Chronic HCV patients with baseline thrombocytopenia are often

excluded from treatment with peginterferon alfa and ribavirin or undergo many

dose reductions of peginterferon alfa. The aim of this study was to investigate

the correlation between thrombocytopenia and the occurrence of bleedings during

antiviral treatment for HCV infection. METHODS: In this single center cohort

study 2876 visits of 321 patients treated with peginterferon alfa and ribavirin

were evaluated for thrombocytopenia, bleedings and dose reductions during HCV

treatment. RESULTS: Mean platelet count at baseline was 207,000/mul for

non-cirrhotic patients (n=253) and 132,000/mul for cirrhotic patients (n=68).

Mean platelet drop was 42% from 191,000 to 113,100/mul (range 8000-284,000/mul).

Severe thrombocytopenia (platelet counts <50,000/mul) was observed in 30

patients (9.3%) at 166 visits and 9 patients developed platelet counts

<25,000/mul at 15 visits. Forty-eight bleedings were observed in 27 patients

(8.4%). Only one bleeding, due to gastrointestinal angiodysplasia, was defined

as severe. However, this patient did not have severe thrombocytopenia at the

time of bleeding. During visits, patients reported more minor bleedings when

platelet counts were <50,000/mul compared to visits with platelet counts

50,000/mul (11.4% vs. 1.1%, p<0.001). In the multivariate analysis, platelet

count of <50,000/mul was a significant predictor of bleeding (p<0.001).

CONCLUSION: Severe bleedings did not occur in patients with platelet counts

below 50,000/mul; based on these findings, treatment with peginterferon alfa and

ribavirin appears to be safe in patients with platelet counts below 50,000/mul

although platelet counts below 25,000/mul were rare. . Published

by Elsevier B.V.

PMID: 20561709 [PubMed - as supplied by publisher]

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June 27, 2010