Erythropoietin increases platelet reactivity and platelet counts in patients with alcoholic liver cirrhosis: a randomized, double-blind, placebo-controlled study.
BACKGROUND
Patients with liver cirrhosis have a complex haemostasis disturbance including thrombocytopenia and abnormal bleeding time. Erythropoietin is the primary stimulator for erythrocyte production and also induces megakaryocyte formation. In healthy men erythropoietin increased platelet count and platelet reactivity.


OBJECTIVE
As patients with liver cirrhosis often undergo invasive procedures, we were interested to study whether erythropoietin could improve platelet function in addition to thrombocytopenia.


METHODS
In total, 22 thrombocytopenic (platelet counts < 120 g/L) patients with alcoholic liver cirrhosis received either 100 IE/kg erythropoietin or placebo on days 1, 3 and 5 in a 2:1 randomized, placebo-controlled double-blind fashion. Platelet counts and platelet reactivity (activator-stimulated expression of P-selectin on platelets measured by flow cytometry) were determined on study days 1, 3, 5 and 9.


RESULTS
Median platelet count was 80 g/L which is borderline for major elective surgical interventions. Baseline values were not different between groups (P > 0.05). Treatment with erythropoietin increased platelet count by 25% (P = 0.01) and platelet reactivity twofold (P < 0.01) vs. baseline. The increase in platelet count vs. baseline was more pronounced in patients with platelet counts <80 g/L. No significant effect was observed in the placebo group.


CONCLUSIONS
Treatment with erythropoietin significantly increased platelet counts and platelet reactivity in patients with alcoholic liver cirrhosis. Preoperative treatment with erythropoietin is therefore expected to yield higher platelet levels and better platelet function.
Clinical Pharmacology-TARGET, Vienna University School of Medicine, Wien, Austria. monika.homoncik@univie.ac.at
M
M
Homoncik
P
P
Jilma-Stohlawetz
M
M
Schmid
A
A
Ferlitsch
M
M
Peck-Radosavljevic
D000328:Adult; D001760:Bleeding Time; D001792:Blood Platelets / Q000187:drug effects; D004311:Double-Blind Method; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017701:Reticulocyte Count; D012156:Reticulocytes / Q000187:drug effects; D013921:Thrombocytopenia / Q000097:blood / Q000628:therapy*
D004921:Erythropoietin