Year 2021 / Volume 113 / Number 2
Review
Avatrombopag for the management of thrombocytopenia in patients with chronic liver disease

136-140

DOI: 10.17235/reed.2020.7309/2020

María Luisa Lozano,

Abstract
Severe thrombocytopenia (platelet count < 50 x 109/l) is the most frequent hematological disorder in patients with chronic liver disease, affecting 64-84 % of individuals with cirrhosis. The pathophysiological mechanisms that underlie thrombocytopenia are complex, but the reduction of thrombopoietin levels is considered to play a key role. Until recently, there was a continuous debate about the optimal management of patients with chronic liver disease and whether low platelet counts require a scheduled invasive procedure. Transfusion of platelet concentrates is considered to be the standard treatment, but has major limitations such as its short lifespan, limited efficacy and relevant adverse effects. Avatrombopag is an oral thrombopoietin receptor agonist that induces megakaryocytic proliferation and differentiation and platelet production. It has been approved by the Spanish Agency of Medicines and Health Products for the treatment of severe thrombocytopenia in adult patients with chronic liver disease before scheduled procedures, to decrease the risk of bleeding. Randomized trials have demonstrated that this agent is effective in maintaining platelet counts above 50 × 109/l over a period of more than two weeks, with a similar safety profile to the placebo. In this article, we review avatrombopag in the treatment of thrombocytopenia in patients with chronic liver disease. Furthermore, the main differences of this intervention in comparison to the previous standard of care therapy are discussed.
Share Button
New comment
Comments

18/04/2023 0:00:52
RECOVERY OF LOST FUNDS FROM SCAMMER.

Tracking Down Lost Bitcoins and Other Cryptos: Fast without wasting time Contact: Telegram: https://t.me/WizardWebRecovery / Email: wizardwebrecovery@gmail.com, Do you need support of recovery of your lost or stolen bitcoin, trying to obtain cryptocurrency transferred to the wrong wallet address, or believe your wallet has been compromised, get in touch with Wizard Web Recovery Group Hackers . I lost over 412,040 $ after participating in a SINCODE binary scam. The money I fraudulently lost has been recovered thanks to the super work of Wizard Web Recovery Group Hackers . They Working with the new digital software that recovers funds without a twinkle of eyes beep Wizard Web Recovery Group Hackers is trustworthy you can always contact them via
Telegram: https://t.me/WizardWebRecovery
Email: wizardwebrecovery@gmail.com


References
1. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. The New England journal of medicine. 2011;365(2):147-56. doi:10.1056/NEJMra1011170
2. Afdhal N, McHutchison J, Brown R, et al. Thrombocytopenia associated with chronic liver disease. Journal of hepatology. 2008;48(6):1000-7. doi:10.1016/j.jhep.2008.03.009
3. Glance LG, Blumberg N, Eaton MP, et al. Preoperative thrombocytopenia and postoperative outcomes after noncardiac surgery. Anesthesiology. 2014;120(1):62-75. doi:10.1097/ALN.0b013e3182a4441f
4. Slichter SJ. Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev. 2004;18(3):153-67. doi:10.1016/j.tmrv.2004.03.003
5. Ware J, Corken A, Khetpal R. Platelet function beyond hemostasis and thrombosis. Curr Opin Hematol. 2013;20(5):451-6. doi:10.1097/MOH.0b013e32836344d3
6. Miller JB, Figueroa EJ, Haug RM, Shah NL. Thrombocytopenia in Chronic Liver Disease and the Role of Thrombopoietin Agonists. Gastroenterol Hepatol (N Y). 2019;15(6):326-32.
7. Estcourt LJ, Birchall J, Allard S, et al. Guidelines for the use of platelet transfusions. British journal of haematology. 2017;176(3):365-94. doi:10.1111/bjh.14423
8. Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. I. The pre-operative period. Blood transfusion = Trasfusione del sangue. 2011;9(1):19-40. doi:10.2450/2010.0074-10
9. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver D. Liver biopsy. Hepatology. 2009;49(3):1017-44. doi:10.1002/hep.22742
10. Tripodi A, Primignani M, Chantarangkul V, et al. Thrombin generation in patients with cirrhosis: the role of platelets. Hepatology. 2006;44(2):440-5. doi:10.1002/hep.21266
11. Giannini EG, Greco A, Marenco S, Andorno E, Valente U, Savarino V. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol. 2010;8(10):899-902; quiz e109. doi:10.1016/j.cgh.2010.06.018
12. 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(10):877-83. doi:10.1016/j.cgh.2010.03.025
13. Basili S, Raparelli V, Napoleone L, et al. Platelet Count Does Not Predict Bleeding in Cirrhotic Patients: Results from the PRO-LIVER Study. Am J Gastroenterol. 2018;113(3):368-75. doi:10.1038/ajg.2017.457
14. Napolitano G, Iacobellis A, Merla A, et al. Bleeding after invasive procedures is rare and unpredicted by platelet counts in cirrhotic patients with thrombocytopenia. Eur J Intern Med. 2017;38:79-82. doi:10.1016/j.ejim.2016.11.007
15. Lozano ML, Rivera J, Bermejo E, Corral J, Perez E, Vicente V. In vitro analysis of platelet concentrates stored in the presence of modulators of 3',5' adenosine monophosphate, and organic anions. Transfus Sci. 2000;22(1-2):3-11. doi:10.1016/s0955-3886(00)00002-3
16. Lozano ML, Rivera J, Vicente V. [Platelet concentrates from whole-blood donations (buffy-coat) or apheresis: which one to use?]. Med Clin (Barc). 2012;138(12):528-33. doi:10.1016/j.medcli.2011.05.008
17. Heinrich S, Loop T. Preoperative treatment of anemia-could an ultra-short-term multimodal approach be beneficial for patients undergoing lung surgery? J Thorac Dis. 2019;11(Suppl 15):S1913-S5. doi:10.21037/jtd.2019.08.95
18. Schiffer CA, Bohlke K, Delaney M, et al. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018;36(3):283-99. doi:10.1200/JCO.2017.76.1734
19. Tripodi A, Primignani M, Chantarangkul V, et al. Global hemostasis tests in patients with cirrhosis before and after prophylactic platelet transfusion. Liver Int. 2013;33(3):362-7. doi:10.1111/liv.12038
20. Intagliata NM, Caldwell SH. Management of disordered hemostasis and coagulation in patients with cirrhosis. Clin Liver Dis (Hoboken). 2014;3(6):114-7. doi:10.1002/cld.333
21. 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(1):679-719. doi:10.1080/16078454.2019.1662200
22. Terrault N, Chen YC, Izumi N, et al. Avatrombopag Before Procedures Reduces Need for Platelet Transfusion in Patients With Chronic Liver Disease and Thrombocytopenia. Gastroenterology. 2018;155(3):705-18. doi:10.1053/j.gastro.2018.05.025
23. Afdhal NH, Giannini EG, Tayyab G, et al. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia. The New England journal of medicine. 2012;367(8):716-24. doi:10.1056/NEJMoa1110709
24. Wire MB, Bruce J, Gauvin J, et al. A randomized, open-label, 5-period, balanced crossover study to evaluate the relative bioavailability of eltrombopag powder for oral suspension (PfOS) and tablet formulations and the effect of a high-calcium meal on eltrombopag pharmacokinetics when administered with or 2 hours before or after PfOS. Clinical therapeutics. 2012;34(3):699-709. doi:10.1016/j.clinthera.2012.01.011
25. Al-Samkari H, Kuter DJ. An alternative intermittent eltrombopag dosing protocol for the treatment of chronic immune thrombocytopenia. British journal of clinical pharmacology. 2018;84(11):2673-7. doi:10.1111/bcp.13717
Citation tools
Lozano M. Avatrombopag for the management of thrombocytopenia in patients with chronic liver disease. 7309/2020


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 1975 visits.
This article has been downloaded 554 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 01/06/2020

Accepted: 14/07/2020

Online First: 25/11/2020

Published: 08/02/2021

Article revision time: 36 days

Article Online First time: 177 days

Article editing time: 252 days


Share
This article has been rated by 9 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