PGY2 Clinical Pharmacy Resident Community Health, United States
Introduction: Thrombocytopenia is common in critically ill patients and is often managed by reversing the underlying cause and administering platelets in the setting of bleeding. Romiplostim, a thrombopoietin peptide mimic, increases platelet production by binding to the thrombopoietin receptor and is approved for use in patients with immune thrombocytopenia. Thrombopoietin receptor agonists have also been used for the treatment of thrombocytopenia in patients with chronic liver disease, aplastic anemia, and those undergoing treatment with chemotherapy. The purpose of this study was to evaluate the efficacy of romiplostim for treatment of thrombocytopenia in critically ill patients.
Methods: This was a single center, retrospective cohort study of adult critically ill patients admitted between January 1, 2021 to December 31, 2022. Patients were included if they were initiated on romiplostim while in the intensive care unit for management of thrombocytopenia. The primary outcome was change in mean platelet count 7 and 14 days after romiplostim administration. Secondary outcomes included mean platelet transfusions required prior to and up to 14 days after romiplostim administration and incidence of arterial and venous thrombosis during hospitalization.
Results: Thirty-one patients were included. Mean platelet count increased from 29.6 +/- 23.7 x 109/L to 96.6 +/- 95.2 x 109/L on day 7 (p < 0.001) and 150.8 +/- 115.9 x 109/L on day 14 (p < 0.001). Mean number of platelet transfusions administered was similar between days 1-7 and days 8-14 after romiplostim administration (2.1 +/- 2.5 versus 2.1 +/- 4.2 units, respectively). One patient developed a new venous thromboembolism after romiplostim administration.
Conclusions: Mean platelet count increased by day 14 in critically ill patients with thrombocytopenia after administration of romiplostim, but it is unclear if this was secondary to romiplostim administration or resolution of underly cause. Romiplostim had limited impact on platelet transfusion requirements up to day 14. Future research is needed to further evaluate the utility and cost effectiveness of romiplostim use in this population.
