Oral eltrombopag may be noninferior to intravenous immunoglobulin in the perioperative treatment of patients with immune thrombocytopenia (ITP), though it may also increase thrombosis risk, according to study results published in The Lancet Haematology.

ITP, an autoimmune disease associated with low platelet counts and an increased risk of bleeding, is often asymptomatic, though invasive procedures, such as surgery, can lead to bleeding complications. Intravenous immunoglobulin is often used to prevent such events, though this therapy is in short supply, and may lead to complications such as aseptic meningitis.

Eltrombopag, an oral thrombopoietin receptor agonist used in chronic ITP, yields platelet count responses within 2 weeks of initiation, though it is associated with liver damage and thrombosis. For this noninferiority trial, researchers evaluated the relative safety and efficacy of intravenous immunoglobulin and eltrombopag among patients with ITP undergoing a surgical procedure.

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Of the 74 patients included in this randomized trial, 38 patients were assigned to receive eltrombopag, and 36 patients were assigned to receive immunoglobulin. Among patients in the eltrombopag group, 18 (47%) participants were men, the average age in this arm was 59.8 years, and 29 (76%) patients had chronic ITP. Among members of the immunoglobulin group, 18 (50%) of patients were men, the average age was 62.1 years, and 29 (81%) patients had chronic ITP. Seventeen (45%) and 14 (39%) patients in the eltrombopag and immunoglobulin groups, respectively, underwent major surgery.

The median follow-up was 50 days. An intention-to-treat analysis showed that 30 (79%) patients in the eltrombopag group and 22 (61%) patients in the immunoglobulin group reached perioperative platelet targets (P for noninferiority =.005); 1 case of treatment-related pulmonary embolism and 1 case of vertigo were noted in the eltrombopag group.

“The [noninferior] result suggests that either eltrombopag or intravenous immunoglobulin are reasonable treatment options,” the authors wrote. “The decision to choose one over the other will depend on other factors including patient preference, resource limitations, cost, and individual risk profiles.”

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Arnold DM, Heddle NM, Cook RJ, et al. Perioperative oral eltrombopag versus intravenous immunoglobulin in patients with immune thrombocytopenia: a non-inferiority, multicentre, randomised trial. Lancet Haematol. 2020;7(9):e640-648. doi:10.1016/S2352-3026(20)30227-1