Factors linked to severe thrombocytopenia during antiviral therapy in patients with chronic hepatitis c and pretreatment low platelet counts

Kung-Hung Lin,Hsien-Chung Yu,Wen-Chi Chen,Wei-Lun Tsai,Ping-I Hsu,Chun-Ku Lin,Hoi-Hung Chan,Kwok-Hung Lai

doi:10.1186/1471-230x-12-7

Kung-Hung Lin, Hsien-Chung Yu + Show 6 more

Open Access

https://doi.org/10.1186/1471-230x-12-7

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Abstract

BackgroundBaseline low platelet count (< 150,000/μL) increases the risk of on-treatment severe thrombocytopenia (platelet count < 50,000/μL) in patients with chronic hepatitis C (CHC) undergoing antiviral therapy, which may interrupt treatment. The purpose of this study was to identify risk factors for severe thrombocytopenia during treatment for CHC in patients with baseline thrombocytopenia.MethodsMedical records were reviewed for 125 patients with CHC treated with antiviral therapy according to the standard of care, with regular follow-up examinations. Early platelet decline was defined as platelet decrease during the first 2 weeks of therapy.ResultsSevere thrombocytopenia developed in 12.8% of patients with baseline thrombocytopenia, and predicted a higher therapeutic dropout rate. Multivariate analysis revealed baseline platelet count < 100,000/μL and rapid early platelet decline (> 30% decline in the first 2 weeks) were significantly associated with severe thrombocytopenia (P < 0.001 and 0.003, odds ratios, 179.22 and 45.74, respectively). In these patients, baseline PLT ≥ 100,000/μL and lack of rapid early platelet decline predicted absence of severe thrombocytopenia (negative predictive values were 95.1% and 96.6%, respectively). In contrast, baseline platelet count < 100,000/μL combined with rapid early platelet decline predicted severe thrombocytopenia (positive predictive value was 100%).ConclusionsFor patients with CHC on antiviral therapy, baseline platelet counts < 100,000/μL and rapid early platelet decline can identify patients at high risk of developing on-treatment severe thrombocytopenia.

Highlights

Baseline low platelet count (< 150,000/μL) increases the risk of on-treatment severe thrombocytopenia in patients with chronic hepatitis C (CHC) undergoing antiviral therapy, which may interrupt treatment
Patients with chronic hepatitis C (CHC) treated with antiviral therapy consisting of pegylated interferon-a and ribavirin experience a response superior to that of therapies used in the past
One recent study reported that development of a platelet count < 50,000/μL was independently associated with bleeding during antiviral therapy [5]

Summary

Introduction

Baseline low platelet count (< 150,000/μL) increases the risk of on-treatment severe thrombocytopenia (platelet count < 50,000/μL) in patients with chronic hepatitis C (CHC) undergoing antiviral therapy, which may interrupt treatment. Patients with chronic hepatitis C (CHC) treated with antiviral therapy consisting of pegylated interferon-a (peg-IFN-a) and ribavirin experience a response superior to that of therapies used in the past. This combination is the current standard of care [1]; side effects, especially hematologic abnormalities, may decrease both therapeutic adherence and the therapeutic success rate. There is no approved therapy for reversing the decline in platelet count, even though some anti-thrombocytopenia therapies are currently under investigation [6]. Discontinuation of anti-viral therapy is the only way to prevent progressive thrombocytopenia; discontinuation of therapy may reduce the rate of viral clearance and sustained virological response (SVR) [8]

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