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J Hepatol. 2010 Sep;53(3):455-9. doi: 10.1016/j.jhep.2010.04.013. Epub 2010 Jun 1.

Thrombocytopenia and the risk of bleeding during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.

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Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.



Chronic HCV patients with baseline thrombocytopenia are often excluded from treatment with peginterferon alfa and ribavirin or undergo many dose reductions of peginterferon alfa. The aim of this study was to investigate the correlation between thrombocytopenia and the occurrence of bleedings during antiviral treatment for HCV infection.


In this single center cohort study 2876 visits of 321 patients treated with peginterferon alfa and ribavirin were evaluated for thrombocytopenia, bleedings and dose reductions during HCV treatment.


Mean platelet count at baseline was 207,000/microl for non-cirrhotic patients (n=253) and 132,000/microl for cirrhotic patients (n=68). Mean platelet drop was 42% from 191,000 to 113,100/microl (range 8000-284,000/microl). Severe thrombocytopenia (platelet counts <50,000/microl) was observed in 30 patients (9.3%) at 166 visits and 9 patients developed platelet counts <25,000/microl at 15 visits. Forty-eight bleedings were observed in 27 patients (8.4%). Only one bleeding, due to gastrointestinal angiodysplasia, was defined as severe. However, this patient did not have severe thrombocytopenia at the time of bleeding. During visits, patients reported more minor bleedings when platelet counts were <50,000/microl compared to visits with platelet counts 50,000/microl (11.4% vs. 1.1%, p<0.001). In the multivariate analysis, platelet count of <50,000/microl was a significant predictor of bleeding (p<0.001).


Severe bleedings did not occur in patients with platelet counts below 50,000/microl; based on these findings, treatment with peginterferon alfa and ribavirin appears to be safe in patients with platelet counts below 50,000/microl although platelet counts below 25,000/microl were rare.

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