Is a platelet count of 113 within the normal range acceptable for surgery in a patient on Promacta (eltrombopag) and should Promacta be stopped before surgery?

Platelet Count of 113 for Surgery in a Patient on Promacta

A platelet count of 113 × 10^9/L is acceptable for most surgical procedures in a patient on Promacta (eltrombopag), and Promacta should be continued perioperatively to maintain this adequate platelet level. 1

Platelet Count Thresholds for Surgery

• According to clinical guidelines, a platelet count of ≥50 × 10^9/L is generally considered the minimum threshold for most major surgical procedures 2, 1
• The patient's current count of 113 × 10^9/L exceeds this threshold by a significant margin, making it adequate for most surgical interventions
• For context:
  • Platelet counts <50 × 10^9/L require prophylactic platelet transfusion before major surgery 1
  • Counts between 50-100 × 10^9/L are associated with increased bleeding risk but are generally acceptable 3
  • Counts >100 × 10^9/L (like this patient's 113) are considered safe for most procedures 1

Management of Promacta (Eltrombopag) Perioperatively

• Promacta should be continued perioperatively to maintain the current platelet level, as discontinuation could lead to a rapid decline in platelet count 4
• Eltrombopag (Promacta) is a thrombopoietin receptor agonist that stimulates platelet production, and its effects have been shown to be beneficial in maintaining adequate platelet counts for patients with thrombocytopenia 4
• Stopping Promacta before surgery could result in a decrease in platelet count, potentially increasing bleeding risk during the procedure

Perioperative Monitoring Recommendations

• Obtain a platelet count on the day of surgery to confirm the count remains >50 × 10^9/L 2, 1
• Have additional platelets available on short notice in case of intraoperative or postoperative bleeding 1
• Monitor for post-surgical bleeding, as patients with platelet counts between 100-150 × 10^9/L still have a slightly elevated risk of bleeding events compared to those with counts >150 × 10^9/L (OR 1.21) 3

Important Considerations

• The type and complexity of the planned surgery should be taken into account:

  • For neurosurgical procedures or procedures with high bleeding risk, some guidelines suggest higher thresholds (up to 100 × 10^9/L) 1
  • For minor procedures, the current platelet count is more than adequate

• Assess for other factors that might increase bleeding risk:

  • Concomitant anticoagulant or antiplatelet medications
  • Liver dysfunction
  • Uremia
  • Coagulation disorders

Common Pitfalls to Avoid

• Don't assume platelet function is normal based solely on count; Promacta increases platelet number but doesn't necessarily affect platelet function
• Avoid unnecessary platelet transfusions when counts are already adequate (>50 × 10^9/L), as this patient's count of 113 × 10^9/L is well above this threshold 2, 1
• Don't discontinue Promacta without considering the risk of platelet count dropping below surgical thresholds 4

In summary, with a platelet count of 113 × 10^9/L, this patient can safely undergo most surgical procedures while continuing Promacta therapy to maintain this adequate platelet level.