Romiplostim for the management of perioperative thrombocytopenia

• Published in: British journal of haematology Vol. 182; no. 1; pp. 106 - 113
• Main Authors: Al‐Samkari, Hanny, Marshall, Ariela L., Goodarzi, Katayoon, Kuter, David J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.07.2018
• Subjects: Adult; Aged; Aged, 80 and over; Bleeding; Blood platelets; Dose-Response Relationship, Drug; Erythrocyte Transfusion; Female; Heart surgery; Hematologic Agents - administration & dosage; Hematologic Agents - adverse effects; Hematologic Agents - therapeutic use; Hematology; Hip; Humans; Idiopathic thrombocytopenic purpura; Joint surgery; Liver; Liver diseases; Male; Malignancy; Middle Aged; Patients; perioperative; Perioperative Care - methods; Platelet Count; Platelet Transfusion; Platelets; Postoperative Complications; Receptors, Fc - administration & dosage; Receptors, Fc - therapeutic use; Receptors, Thrombopoietin - agonists; Recombinant Fusion Proteins - administration & dosage; Recombinant Fusion Proteins - adverse effects; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; romiplostim; Surgery; Thrombocytopenia; Thrombocytopenia - blood; Thrombocytopenia - drug therapy; Thrombocytopenia - etiology; Thromboembolism; Thrombopoietin; Thrombopoietin - administration & dosage; Thrombopoietin - adverse effects; Thrombopoietin - therapeutic use; thrombopoietin receptor agonist; Thrombosis; Total hip arthroplasty; Transfusion; Young Adult; perioperative; thrombopoietin receptor agonist; romiplostim; bleeding; thrombocytopenia; surgery
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.15280

Summary Thrombocytopenic patients requiring invasive surgery have few options to improve their platelet count preoperatively. This is a single‐centre, retrospective review of thrombocytopenic patients receiving the thrombopoietin receptor agonist romiplostim perioperatively to allow for surgical interventions. Patient characteristics, romiplostim use, and surgical and safety outcomes (bleeding, thrombosis, transfusions) were collected and analysed. Forty‐seven patients underwent 51 surgical procedures (ranging from total hip arthroplasty to open cardiac surgery) with romiplostim support. Thrombocytopenia aetiologies included immune thrombocytopenia, chronic liver disease, haematological malignancy, drug‐related thrombocytopenia, and hereditary thrombocytopenia. Median (range) platelet counts improved, from 47 × 109/l (9–120 × 109/l) at romiplostim initiation to 164 × 109/l (28–603 × 109/l) at the time of surgery (P < 0·0001). A dose of 3 μg/kg per week for 2 doses increased the platelet count to >100 × 109/l in 79% of patients within 14 days. In 96% of cases, surgery proceeded on schedule without delay or cancellation. Four patients had bleeding events unrelated to thrombocytopenia and 1 patient developed deep venous thrombosis. Six patients required red cell transfusion and 3 patients required platelet transfusion perioperatively. In conclusion, romiplostim was effective in increasing platelet counts to allow surgery to proceed safely and on schedule. Bleeding and thromboembolic events were within acceptable limits for this surgical population.