Effect of Rifaximin on Thrombocytopenia in Patients With HCV-Related Liver Cirrhosis

Summary

Cirrhosis is a common complication of chronic hepatitis C virus (HCV) infection in Egypt. Thrombocytopenia (TP) is the most common cytopenia in patients with cirrhosis and may be associated with variceal bleeding, rebleeding, morbidity, and mortality. Although TP has traditionally been attributed to portal hypertension and splenic sequestration, other mechanisms include impaired thrombopoietin activity, bone marrow suppression, and increased platelet destruction. Rifaximin is a poorly absorbed, broad-spectrum intestinal antimicrobial agent widely used in patients with cirrhosis, particularly for hepatic encephalopathy. Its minimal systemic absorption limits systemic adverse effects. Rifaximin may reduce intestinal bacterial overgrowth and bacterial translocation, thereby decreasing circulating endotoxin and proinflammatory cytokines that may contribute to haematological abnormalities in cirrhosis. Previous observations have suggested that intestinal decontamination with rifaximin may increase platelet counts in patients with cirrhosis and thrombocytopenia. This randomised controlled trial was designed to investigate whether rifaximin treatment could improve platelet count in patients with HCV-related liver cirrhosis and thrombocytopenia.

Timeline

Start

2015-10-19

Primary completion

2017-11-30

Completion

2017-12-30

Publications

• Background Qamar AA, Grace ND. Abnormal hematological indices in cirrhosis. Can J Gastroenterol. 2009 Jun;23(6):441-5. doi: 10.1155/2009/591317.
• Background Koo HL, DuPont HL. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases. Curr Opin Gastroenterol. 2010 Jan;26(1):17-25. doi: 10.1097/MOG.0b013e328333dc8d.
• Background Afdhal N, McHutchison J, Brown R, Jacobson I, Manns M, Poordad F, Weksler B, Esteban R. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008 Jun;48(6):1000-7. doi: 10.1016/j.jhep.2008.03.009. Epub 2008 Mar 31.
• Background Kalambokis G, Tsianos EV. Endotoxaemia in the pathogenesis of cytopenias in liver cirrhosis. Could oral antibiotics raise blood counts? Med Hypotheses. 2011 Jan;76(1):105-9. doi: 10.1016/j.mehy.2010.08.043. Epub 2010 Sep 15.
• Background Garcia-Tsao G, Wiest R. Gut microflora in the pathogenesis of the complications of cirrhosis. Best Pract Res Clin Gastroenterol. 2004 Apr;18(2):353-72. doi: 10.1016/j.bpg.2003.10.005.
• Background Kalambokis G, Tsianos EV. Thrombocytopenia associated with chronic liver disease: effects of rifaximin on platelet count. Am J Gastroenterol. 2010 Dec;105(12):2705-7. doi: 10.1038/ajg.2010.364. No abstract available.
• Background Witters P, Freson K, Verslype C, Peerlinck K, Hoylaerts M, Nevens F, Van Geet C, Cassiman D. Review article: blood platelet number and function in chronic liver disease and cirrhosis. Aliment Pharmacol Ther. 2008 Jun 1;27(11):1017-29. doi: 10.1111/j.1365-2036.2008.03674.x. Epub 2008 Mar 5.
• Background Liangpunsakul S, Ulmer BJ, Chalasani N. Predictors and implications of severe hypersplenism in patients with cirrhosis. Am J Med Sci. 2003 Sep;326(3):111-6. doi: 10.1097/00000441-200309000-00001.
• Background Balabaud C, Bioulac-Sage P. Cirrhosis: what else? Gastroenterol Clin Biol. 2010 Apr-May;34(4-5):252-4. doi: 10.1016/j.gcb.2010.03.007. Epub 2010 May 27.

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