Romiplostim
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Portal vein thrombosis: case report A 50-year-old woman developed portal vein thrombosis during treatment with romiplostim for hepatitis Cassociated immune thrombocytopenic purpura (ITP). The woman, who had Child class B liver cirrhosis due to chronic hepatitis C, began receiving SC romiplostim 500 µg/week for the treatment of ITP. Nine months later, she was hospitalised with general malaise and worsening hydropic decompensation. She had a platelet count of >330 000/µL. Abdominal ultrasound revealed a thrombus in the extrahepatic portal vein, with large amounts of ascitic fluid. Portal vein peak-flow was 22 cm/sec according to doppler sonography. A CT scan confirmed the presence of a localised thrombus at the intersection of the superior mesenteric vein into the portal vein. Treatment with romiplostim was discontinued. The woman began receiving heparin, with an improvement in her condition. Nine days later, intra-arterial digital subtraction angiography showed complete recanalisation of the portal vein, with no thrombus material in the celiac trunk and inferior vena cava. She was discharged on lowmolecular weight heparin. Author comment: "[C]oincidence of exceeding increase in platelet count and onset of portal vein thrombosis suggests a causal role of romiplostim . . ." Dultz G, et al. Portal vein thrombosis as complication of romiplostim treatment in a cirrhotic patient with hepatitis C-associated immune thrombocytopenic purpura. Journal of Hepatology 55: 229-232, No. 1, Jul 2011. Available from: URL: http:// 803058002 dx.doi.org/10.1016/j.jhep.2011.01.020 - Germany
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Reactions 30 Jul 2011 No. 1362
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