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

After approval by the Ethics Committee of the Faculty of Medicine, Fayoum University,patients were recruited from two tertiary university hospitals in Egypt. Written informedconsent was obtained from all patients before enrolment. This was a double‐blind,randomised controlled clinical trial that included 165 adults aged 18‐75 years withHCV‐related liver cirrhosis and thrombocytopenia who had previously received treatmentfor HCV and achieved a sustained virologic response.Cirrhosis was diagnosed based on clinical findings (splenomegaly, ascites, and/oresophageal varices), laboratory findings (hypoalbuminemia, hyperbilirubinemia, and/orprolonged prothrombin time), and imaging findings on abdominal ultrasonography, computedtomography, and/or magnetic resonance imaging, with liver biopsy considered whenavailable. The severity of cirrhosis was assessed using the Child‐Pugh classification.Thrombocytopenia was defined as a platelet count <150,000/mm³ and classified as mild(>75,000/mm³), moderate (50,000‐75,000/mm³), or severe (<50,000/mm³). Anaemia was definedas haemoglobin <13.5 g/dL in men and <11.5 g/dL in women, and leukopenia as a white bloodcell count <4,000/mm³.Patients were randomly assigned in a 1:1 allocation ratio to the rifaximin group (n=85),which received rifaximin 550 mg orally twice daily for 4 weeks, or the placebo group(n=80). At baseline, all patients underwent clinical evaluation, complete blood count,liver and kidney function tests, and abdominal ultrasonography. A follow‐up completeblood count was performed after 4 weeks. Patients were followed weekly in the outpatienthepatology clinic to assess treatment compliance, adverse effects, and cirrhosis‐relatedcomplications