Mohamed Sabah E, Yassin Mohamed A
Department of internal medicine, Hamad medical corporation, Doha, Qatar.
National Centre for Cancer and Research, Hamad Medical Corporation, Doha, Qatar.
Case Rep Oncol. 2020 Jul 28;13(2):863-866. doi: 10.1159/000507987. eCollection 2020 May-Aug.
Off-label drug use refers to drug use beyond the specifications authorized for marketing [J Med Case Rep. 2014 Dec;8(1):303]. Eltrombopag is a thrombopoietin receptor agonist that has been used in treating thrombocytopenia due to chronic liver disease (CLD) as an off-label medication. Treatment of thrombocytopenia in patients with CLD constitute a real dilemma as the options are limited and some of them are invasive. However, thrombopoietin receptor agonist has been increasingly used for this purpose. Here we report a 34-year-old woman who has been diagnosed with CLD due to autoimmune hepatitis 20 years ago. Her condition was complicated with portal vein thrombosis, chronic thrombocytopenia, and variceal hemorrhage, and she has been listed as a candidate for liver transplantation. Given her high risk of bleeding, we started her on low dose of eltrombopag (25 mg daily) in order to maintain a platelet level of ≥50 × 10/µL. However, 1 year after initiation of the therapy, she developed left lower limb deep vein thrombosis.
药物的超说明书使用是指超出药品上市许可规定范围的用药行为[《医学案例报告》。2014年12月；8(1):303]。艾曲泊帕是一种血小板生成素受体激动剂，已被作为超说明书用药用于治疗慢性肝病（CLD）所致的血小板减少症。治疗CLD患者的血小板减少症是一个真正的难题，因为治疗选择有限且其中一些具有侵入性。然而，血小板生成素受体激动剂已越来越多地用于此目的。在此，我们报告一名34岁女性，她于20年前被诊断为自身免疫性肝炎所致的CLD。她的病情并发门静脉血栓形成、慢性血小板减少症和静脉曲张出血，并且她已被列为肝移植候选者。鉴于她有高出血风险，我们让她开始服用低剂量的艾曲泊帕（每日25毫克），以维持血小板水平≥50×10⁹/µL。然而，在开始治疗1年后，她发生了左下肢深静脉血栓形成。
