Portal Vein Thrombosis during Eltrombopag Treatment for Immune Thrombocytopenic Purpura in a Patient with Liver Cirrhosis due to Hepatitis C Viral Infection

DOI PubMed 被引用文献1件 参考文献26件
  • Kawano Noriaki
    Department of Internal Medicine, Miyazaki Prefectural Hospital
  • Hasuike Satoru
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
  • Iwakiri Hisayoshi
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
  • Nakamura Kenichi
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
  • Ozono Yoshinori
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
  • Kusumoto Hisanori
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
  • Nagata Kenji
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
  • Kikuchi Ikuko
    Department of Internal Medicine, Miyazaki Prefectural Hospital
  • Yoshida Shuro
    Department of Internal Medicine, Miyazaki Prefectural Hospital
  • Kuriyama Takuro
    Department of Internal Medicine, Miyazaki Prefectural Hospital
  • Yamashita Kiyoshi
    Department of Internal Medicine, Miyazaki Prefectural Hospital
  • Muranaka Takahiro
    Department of Radiology, Miyazaki Prefectural Hospital
  • Kawaguchi Takumi
    Division of Gastroenterology, Department of Medicine, and Department of Digestive Disease Information & Research, Kurume University School of Medicine
  • Sata Michio
    Division of Gastroenterology, Department of Medicine, and Department of Digestive Disease Information & Research, Kurume University School of Medicine
  • Okamura Takashi
    Department of Internal Medicine, Hematology, Kurume University
  • Ueda Akira
    Department of Internal Medicine, Miyazaki Prefectural Hospital
  • Shimoda Kazuya
    Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University

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Portal vein thrombosis is a rare, aggressive andlife-threatening complication of liver cirrhosis (LC). Eltrombopag is effective for the treatment of chronic hepatitis with thrombocytopenia, andportal vein thrombosis at this time has rarely been reported. We describe the case of a 78-year-old woman who suffered from LC due to hepatitis C viral infection. The patient developed immune thrombocytopenic purpura (ITP) that was diagnosed on the basis of nasal bleeding, progressive severe thrombocytopenia, elevation of platelet-associatedIgG (PAIgG), no response to the transfusion of platelets andno abnormal findings on bone marrow biopsy. Although we first administered prednisolone (0.5 mg/kg/day), there was no recovery of platelet function and the nasal bleeding persisted. Subsequently, we administered eltrombopag for refractory ITP at a dose of 12.5 mg/day, and the thrombocytopenia gradually improved. Fifty-four days after the start of eltrombopag therapy, she developedportal vein thrombosis. Eltrombopag was stoppedimmed iately, andantithrombin III was administeredfor prophylaxis against further portal vein thrombosis. Despite these treatments, there were subsequent deep vein and pulmonary artery thromboses. We then administered heparin for recanalization of the thrombi. One month after the initiation of heparin, there was recanalization as well as improvements of the portal vein, deep vein and pulmonary artery thromboses. There was no further thrombosis progression after switching from heparin to warfarin therapy. Our case suggests that eltrombopag may increase the risk of portal vein thrombosis ; therefore, this drug must be used carefully in the treatment of ITP in patients with LC due to hepatitis C viral infection. [J Clin Exp Hematop 53(2) : 151-155, 2013]

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