| [ Summary ] |
Patients with chronic liver disease often have pancytopenia due to hypersplenism caused by advanced liver fibrosis. Thrombocytopenia often interferes with invasive procedures, including radiofrequency ablation. In chronic liver disease associated with the hepatitis C virus, low platelet counts present a major obstacle in carrying out interferon treatment. Therefore, two procedures, PSE and splenectomy, are performed as countermeasures to treat thrombocytopenia. Splenectomies or PSE are effective treatments when thrombocytopenia is present. However, many complications regarding patientsʼ safety are observed with both splenectomies and PSE. Platelet counts often increase after splenectomies and/or PSE, thus resulting in improvements in IFN treatment. However, increased SVR rates are not common in patients with HCV genotype 1b involvement and high viral loads. Eltrombopag is another effective treatment method for thrombocytopenia. Several investigations have reported eltrombopag, to be a less invasive but effective treatment for hypersplenism in patient with cirrhosis. Eltrombopag increases platelet numbers in thrombocytopenic patients with HCV and advanced fibrosis and cirrhosis, allowing otherwise ineligible or marginal patients to begin or continue IFN therapy. However, an increased risk of portal-vein thrombosis was observed in patients receiving eltrombopag. IFN-free antiviral treatments could be another alternative for patients with a low platelet counts. |