PURPOSE: Anecdotal reports have suggested an association of drop in platelet count in patients receiving chronic epoprostenol (epo) infusion for pulmonary arterial hypertension (PAH). This could potentially lead to bleeding complications and the need for either dose reduction or discontinuation of therapy.
METHODS: Retrospective chart review to document platelet counts in PAH patients before and after initiation of epo between 2000–2008. Data presented as mean ± SEM. Epo doses are ng/kg/min. Platelet counts are reported in thousands.
RESULTS: We identified 27 patients who received epo. We were able to obtain pre-post platelet count data in 20 of them. Mean age was 58 and 60 % were female. Main etiologies were: 8 idiopathic PAH, 8 PAH-associated diseases, 3 thromboembolic and 1 sarcoidosis-associated. Mean platelet count was 195 at baseline and 205 at 6 months (p= 0.26). Platelet count dropped in 9 patients by a mean of 48 (median 36). Four patients dropped by more than 50 thousand (55, 62, 71 and 139).
CONCLUSION: In our cohort, epo did not lead to a significant drop in platelet count. However, a few patients did experience a large drop in platelet count. Experts have suggested either a dose reduction or discontinuation of epo therapy in cases where severe and refractory thrombocytopenia occurs.
CLINICAL IMPLICATIONS: Given the active use of epo for severe PAH, better understanding of the potential hematologic manifestations of this drug could have important clinical implications.
DISCLOSURE: Shibin Jacob, Consultant fee, speaker bureau, advisory committee, etc. Honorarium compensation for Advisory Board participation for Gilead Pharmaceuticals, distributor of epoprostenol.; No Product/Research Disclosure Information