title: Portal vein thrombosis as complication of romiplostim treatment in a cirrhotic patient with hepatitis C-associated immune thrombocytopenic purpura.
abstract: OBJECTIVE
  Thrombopoietin receptor agonists are a new class of compounds licenced for the treatment of immune thrombocytopenic purpura. They are currently being studied for patients with thrombopenia in advanced liver disease or under therapy for hepatitis C. There are indications that the risk for development of portal vein thrombosis in patients with advanced liver cirrhosis might be increased under therapy with thrombopoietin receptor agonists. We report a case of a patient with Child class B liver cirrhosis with concurrent immune thrombocytopenic purpura that developed portal vein thrombosis under therapy with the thrombopoietin receptor agonist romiplostim.
  
  
  METHODS
  A 50-year-old woman with hepatitis C virus associated immune thrombocytopenic purpura and Child class B liver cirrhosis presented in our emergency with rapidly evolving hydropic decompensation and general malaise. For immune thrombocytopenic purpura, the patient was started on the thrombopoietin receptor agonist romiplostim nine months ago.
  
  
  RESULTS
  During hospitalization, the platelet count was measured above 330,000/μl and partial portal vein thrombosis was diagnosed by imaging studies. The thrombotic event was assumed to be associated with the romiplostim treatment for immune thrombocytopenic purpura via excessive elevation of platelet count. After anticoagulation with heparin and cessation of romiplostim treatment, complete recanalisation of the portal vein was achieved.
  
  
  CONCLUSIONS
  We conclude that romiplostim should be used with precaution in patients with hepatitis C-associated immune thrombocytopenic purpura and advanced liver cirrhosis as the risk for thrombotic complications may increase significantly.
authors.affiliation: Medizinische Klinik 1, Klinikum der J.W. Goethe-Universität, Frankfurt am Main, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Dultz
authors.forename: Bernd
authors.initials: B
authors.lastname: Kronenberger
authors.forename: Alireza
authors.initials: A
authors.lastname: Azizi
authors.forename: Ulrike
authors.initials: U
authors.lastname: Mihm
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.forename: Ulrike
authors.initials: U
authors.lastname: Sarrazin
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Wolf-Peter
authors.initials: WP
authors.lastname: Hofmann
mesh_terms: D015901:Angiography, Digital Subtraction; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D011169:Portal Vein; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy*; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin / Q000819:agonists; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D012307:Risk Factors; D013926:Thrombopoietin / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim