Year 2020 / Volume 112 / Number 10
Original
Management of chronic liver disease-associated severe thrombocytopenia in Spain: a view from the experts

778-783

DOI: 10.17235/reed.2020.6895/2020

José Luis Calleja-Panero, Raúl J. Andrade, Rafael Bañares, Javier Crespo, Rafael Esteban, Isidro Jarque, María Eva Mingot-Castellano, Manuel Romero-Gómez, Rocío Muñoz-Peñín, Roy Bentley, John Shepherd, Alicia Gil Aguirre,

Abstract
Background: chronic liver disease (CLD) patients often present thrombocytopenia (TCP) and when severe, it may prevent them from undergoing necessary invasive procedures due to an increased bleeding risk. The lack of scientific evidence makes it impossible to determine key aspects of the current management and associated healthcare burden of these patients in Spain. Purpose: to gain insight into the current situation of patients with CLD-associated severe TCP undergoing invasive procedures in Spain, based on the experience of clinical experts. Methods: national Delphi study involving 32 medical experts. Results: the estimated prevalence of CLD-associated severe TCP is approximately 5,967, with an annual incidence of 1,148 new patients. Patients undergo a median of 1 (0-3) invasive procedures/year. Platelet transfusions (PTs) are the standard option to raise platelet counts and are associated with significant burden. The achievement of target platelet levels (≥ 50 x 109/l) after a transfusion is not routinely measured. The lack of effectiveness and short life span of transfused platelets can lead to procedure cancellations and bleeding events, which potentially affect patient outcomes. Adverse events occur in 1-25 % of patients, including mild (febrile and allergic reactions) and severe events (e.g., transfusion-related acute lung injury). Between 5-15 % of patients are unfit to receive PTs and approximately 3 % are treated off-label with thrombopoietin receptor agonists. Conclusions: this study provides a snapshot of the current situation in Spain, highlighting that the current management is poorly standardized and suboptimal in some cases. The results suggest the benefit of developing a consensus document to address some of these shortcomings and to advance in the search for alternatives to PTs.
Share Button
New comment
Comments
No comments for this article
References
1. Afdhal N, McHutchison J, Brown R, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008;48:1000-7.
2. Bashour FN, Teran JC, Mullen KD. Prevalence of peripheral blood cytopenias (hypersplenism) in patients with nonalcoholic chronic liver disease. Am J Gastroenterol. 2000;95:2936-9.
3. Giannini EG. Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options. Aliment Pharmacol Ther. 2006;23:1055-65.
4. Garcia-Tsao G, Friedman S, Iredale J, et al. Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51:1445-9.
5. Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int. 2017;37:778-93.
6. Giannini EG, Greco A, Marenco S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol. 2010;8:899-902; quiz e109.
7. Maan R, de Knegt RJ, Veldt BJ. Management of Thrombocytopenia in Chronic Liver Disease: Focus on Pharmacotherapeutic Strategies. Drugs. 2015;75:1981-92.
8. Hermos JA, Altincatal A, Weber HC, et al. Thrombocytopenia and bleeding in veterans with non-hepatitis C-related chronic liver disease. Dig Dis Sci. 2013;58:562-73.
9. Miller JB, Figueroa EJ, Haug RM, et al. Thrombocytopenia in Chronic Liver Disease and the Role of Thrombopoietin Agonists. Gastroenterol Hepatol (N Y). 2019;15:326-32.
10. Mulpleo (previously Lusutrombopag Shionogi): EPAR - Product Information [Internet]. European Medicines Agency. 2019. Available from: https://www.ema.europa.eu/en/documents/product-information/mulpleo-previously-lusutrombopag-shionogi-epar-product-information_en.pdf.
11. Doptelet: EPAR - Product Information [Internet]. European Medicines Agency. 2020. Available from: https://www.ema.europa.eu/en/documents/product-information/doptelet-epar-product-information_en.pdf.
12. Newland A, Bentley R, Jakubowska A, et al. A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia. Hematology. 2019;24:679-719.
13. Poordad F. Review article: thrombocytopenia in chronic liver disease. Aliment Pharmacol Ther. 2007;26 Suppl 1:5-11.
14. Hess JR. Conventional blood banking and blood component storage regulation: opportunities for improvement. Blood Transfus. 2010;8 Suppl 3:s9-15.
15. Arbona C, Bautista-Gili AM, Castella MD, et al. Guía sobre la transfusión de componentes sanguíneos y derivados plasmáticos. 2015.
16. Riva JJ, Malik KM, Burnie SJ, et al. What is your research question? An introduction to the PICOT format for clinicians. J Can Chiropr Assoc. 2012;56:167-71.
17. Graefe A, Armstrong JS. Comparing face-to-face meetings, nominal groups, Delphi and prediction markets on an estimation task. International Journal of Forecasting. 2011;27:183-95.
18. Meshkat B, Cowman S, Gethin G, et at. Using an e-Delphi technique in achieving consensus across disciplines for developing best practice in day surgery in Ireland. J Hosp Adm. 2014;3:1–8.
19. Instituto Nacional de Estadística [Internet]. Available from: www.ine.es.
20. Fortea JI, Puente A, Ezcurra I, et al. Management of haemostatic alterations and associated disorders in cirrhosis in Spain: A national survey. Dig Liver Dis. 2019;51:95-103.
21. Rios R, Sangro B, Herrero I, et al. The role of thrombopoietin in the thrombocytopenia of patients with liver cirrhosis. Am J Gastroenterol. 2005;100:1311-6.
22. Revolade: EPAR - Product Information [Internet]. European Medicines Agency. 2019. Available from: https://www.ema.europa.eu/en/documents/product-information/revolade-epar-product-information_en.pdf.
23. Nplate: EPAR - Product Information [Internet]. European Medicines Agency. 2019. Available from: https://www.ema.europa.eu/en/documents/product-information/nplate-epar-product-information_en.pdf.
24. Minurin: Product Information [Internet]. Spanish Agency of Medicines and Medical Products. 2017. Available from: http://cima.aemps.es/cima/pdfs/es/ft/61413/61413_ft.pdf.
25. Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69:718–35.
26. Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8:877-83.
27. Poordad F, Theodore D, Sullivan J, et al. Evaluating medical resource utilization and costs associated with thrombocytopenia in chronic liver disease patients. J Med Econ. 2012;15:112-24.
28. Cerqueira RM, Andrade L, Correia MR, et al. Risk factors for in-hospital mortality in cirrhotic patients with oesophageal variceal bleeding. Eur J Gastroenterol Hepatol. 2012;24:551-7.
29. Cho J, Choi SM, Yu SJ, et al. Bleeding complications in critically ill patients with liver cirrhosis. Korean J Intern Med. 2016;31:288-95.
Related articles

Letter

Hepatosplenic T-cell lymphoma and inflammatory bowel disease

DOI: 10.17235/reed.2023.9472/2023

Letter

New technique for the endoscopic removal of long foreign bodies

DOI: 10.17235/reed.2023.9398/2022

Letter

An uncommon colonic polyp

DOI: 10.17235/reed.2022.9160/2022

Letter

POEMS syndrome: an uncommon cause of peritoneal effusion

DOI: 10.17235/reed.2021.8027/2021

Digestive Diseases Image

Phlebosclerotic colitis: an unusual cause of abdominal pain and hematochezia

DOI: 10.17235/reed.2020.7358/2020

Original

Neurogenic ppendicopathy. A report of 8 cases

DOI: 10.17235/reed.2017.4520/2016

Case Report

Primary esophageal melanoma: report of a case

DOI: 10.17235/reed.2016.3908/2015

Letter to the Editor

Unusual course of epiploic appendicitis

DOI: 10.17235/reed.2015.3796/2015

Citation tools
Calleja-Panero J, Andrade R, Bañares R, Crespo J, Esteban R, Jarque I, et all. Management of chronic liver disease-associated severe thrombocytopenia in Spain: a view from the experts. 6895/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 456 visits.
This article has been downloaded 340 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 21/01/2020

Accepted: 29/04/2020

Online First: 21/09/2020

Published: 07/10/2020

Article revision time: 70 days

Article Online First time: 244 days

Article editing time: 260 days


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology