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

Noriaki Kawano; Satoru Hasuike; Hisayoshi Iwakiri; Kenichi Nakamura; Yoshinori Ozono; Hisanori Kusumoto; Kenji Nagata; Ikuko Kikuchi; Shuro Yoshida; Takuro Kuriyama; Kiyoshi Yamashita; Takahiro Muranaka; Takumi Kawaguchi; Michio Sata; Takashi Okamura; Akira Ueda; Kazuya Shimoda

doi:10.3960/jslrt.53.151

Case Study

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

Noriaki Kawano, Satoru Hasuike, Hisayoshi Iwakiri, Kenichi Nakamura, Yoshinori Ozono, Hisanori Kusumoto, Kenji Nagata, Ikuko Kikuchi, Shuro Yoshida, Takuro Kuriyama, Kiyoshi Yamashita, Takahiro Muranaka, Takumi Kawaguchi, Michio Sata, Takashi Okamura, Akira Ueda, Kazuya Shimoda

Author information

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

Keywords: portal vein thrombosis, eltrombopag, immune thrombocytopenic purpura, liver cirrhosis

JOURNAL FREE ACCESS

2013 Volume 53 Issue 2 Pages 151-155

DOI https://doi.org/10.3960/jslrt.53.151

Details

Abstract

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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