Sasaguri Tomoko, Hirakawa Naomi, Uemura Satoko
Pain Clinic and Palliative Care Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
JA Clin Rep. 2018 Nov 20;4(1):80. doi: 10.1186/s40981-018-0217-7.
The oral thrombopoietin (TPO) receptor agonist lusutrombopag (Mulpleta®) was developed to improve thrombocytopenia in patients with chronic liver disease prior to elective invasive medical procedures. Mulpleta® was first approved for use in Japan in 2015 and in the USA in 2018. In the present report, we discuss a case in which pain management was performed during left renal artery embolization via continuous epidural anesthesia following oral administration of lusutrombopag. To our knowledge, this is the first report to discuss the use of lusutrombopag prior to epidural anesthesia.
The patient was a 78-year-old woman scheduled to undergo renal artery embolization to address a 3-cm aneurysm of the left renal artery. Fourteen days prior to the scheduled embolization procedure, the urologist was asked to insert an epidural catheter for perioperative and postoperative analgesia. Type C chronic cirrhosis was observed, and platelet count was 5.6 × 10/μL. Eleven days prior to embolization, oral lusutrombopag was initiated at a dosage of 3 mg/day (day 1). Oral lusutrombopag therapy was continued for 5 days, and platelet count on day 11 (i.e., the day prior to surgery) was 12.6 × 10/μL. An epidural catheter was inserted on day 12, following which embolization was performed. Platelet count on day 13 was 11.0 × 10/μL, and the catheter was removed on day 14. No symptoms of epidural hematoma or thrombosis were observed during the patient's disease course.
As lusutrombopag is a relatively safe platelet-increasing agent, we believe that this drug can serve as a potential treatment option when performing elective epidural anesthesia in patients with chronic liver disease complicated by thrombocytopenia.
口服血小板生成素（TPO）受体激动剂芦曲泊帕（Mulpleta®）旨在改善择期侵入性医疗程序前慢性肝病患者的血小板减少症。Mulpleta®于2015年在日本首次获批使用，2018年在美国获批。在本报告中，我们讨论了一例在口服芦曲泊帕后通过连续硬膜外麻醉进行左肾动脉栓塞术期间进行疼痛管理的病例。据我们所知，这是第一份讨论在硬膜外麻醉前使用芦曲泊帕的报告。
患者为一名78岁女性，计划接受肾动脉栓塞术以治疗左肾动脉3厘米动脉瘤。在预定的栓塞手术前14天，泌尿科医生被要求插入硬膜外导管用于围手术期和术后镇痛。观察到C型慢性肝硬化，血小板计数为5.6×10/μL。在栓塞前11天，开始口服芦曲泊帕，剂量为3毫克/天（第1天）。口服芦曲泊帕治疗持续5天，第11天（即手术前一天）的血小板计数为12.6×10/μL。在第12天插入硬膜外导管，随后进行栓塞。第13天的血小板计数为11.0×10/μL，导管在第14天拔除。在患者病程中未观察到硬膜外血肿或血栓形成的症状。
由于芦曲泊帕是一种相对安全的升血小板药物，我们认为该药物可作为慢性肝病合并血小板减少症患者进行择期硬膜外麻醉时的潜在治疗选择。
