Marshall Ariela L, Goodarzi Katayoon, Kuter David J
Department of Hematology, Massachusetts General Hospital.
Department of Hematology and Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Transfusion. 2015 Oct;55(10):2505-10. doi: 10.1111/trf.13181. Epub 2015 May 30.
Thrombopoietin receptor agonists increase platelet (PLT) counts and are approved for the treatment of chronic immune thrombocytopenia (ITP). These agents may also be useful for the management of thrombocytopenia in patients requiring surgical procedures.
We conducted a retrospective review of patients with thrombocytopenia (baseline PLT count, <150 × 10(9) /L) who received romiplostim before planned operative procedures. We characterized patient demographics, dosing and duration of romiplostim use, success in achieving PLT counts high enough for surgery, and clinical outcomes.
Eighteen patients underwent a total of 22 operative procedures, including three Jehovah's Witnesses who underwent five procedures. Etiologies of thrombocytopenia included mild ITP (not on romiplostim at baseline), liver disease, hematologic malignancy, and drug-related thrombocytopenia. Median PLT count at romiplostim initiation was 47 × 10(9) /L (range, 11 × 10(9) -120 × 10(9) /L). All patients experienced a PLT count increase over a median of 4 weeks; median PLT count at surgery was 144 × 10(9) /L (range, 28 × 10(9) -370 × 10(9) /L). PLT counts increase to more than 150 × 10(9) /L in four of five Jehovah's Witness patients by the time of surgery. There were no surgical delays or cancellations due to thrombocytopenia. Four bleeding events occurred; none were fatal and none occurred at a PLT count of fewer than 80 × 10(9) /L. No definitive thromboembolic events occurred.
Romiplostim successfully increased preoperative PLT counts allowing operative interventions, was well tolerated, did not lead to any significant thromboembolic events, and avoided the need for transfusion. Romiplostim may be of clinical utility in the preoperative management of thrombocytopenic patients, especially those unable to receive or unresponsive to PLT transfusion.
血小板生成素受体激动剂可增加血小板（PLT）计数，已被批准用于治疗慢性免疫性血小板减少症（ITP）。这些药物可能也有助于管理需要进行外科手术患者的血小板减少症。
我们对在计划手术前接受罗米司亭治疗的血小板减少症患者（基线PLT计数<150×10⁹/L）进行了回顾性研究。我们对患者的人口统计学特征、罗米司亭的用药剂量和使用持续时间、血小板计数升高至足以进行手术的成功率以及临床结局进行了描述。
18例患者共接受了22次手术，其中包括3名耶和华见证会信徒，他们接受了5次手术。血小板减少症的病因包括轻度ITP（基线时未使用罗米司亭）、肝病、血液系统恶性肿瘤和药物相关血小板减少症。开始使用罗米司亭时的PLT计数中位数为47×10⁹/L（范围为11×10⁹ - 120×10⁹/L）。所有患者的PLT计数在中位数为4周的时间内均有所增加；手术时的PLT计数中位数为144×10⁹/L（范围为28×10⁹ - 370×10⁹/L）。五名耶和华见证会信徒患者中有四名在手术时PLT计数增加到超过150×10⁹/L。没有因血小板减少症导致手术延迟或取消的情况。发生了4次出血事件；均非致命，且没有一次发生在PLT计数低于80×10⁹/L时。没有明确的血栓栓塞事件发生。
罗米司亭成功提高了术前PLT计数，使手术干预得以进行，耐受性良好，未导致任何显著的血栓栓塞事件，并且避免了输血的需要。罗米司亭在血小板减少症患者的术前管理中可能具有临床应用价值，尤其是那些无法接受或对PLT输血无反应的患者。
