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Treatment Options for Thrombocytopenia in Patients With Chronic Liver Disease Undergoing a Scheduled Procedure
Sammy Saab1, David Bernstein2, Tarek Hassanein3
1David Geffen School of Medicine at UCLA, Los Angeles.
Insights
Thrombocytopenia, a common issue in chronic liver disease (CLD), can be effectively managed with new thrombopoietin receptor agonists before procedures. These treatments improve platelet counts, addressing a significant concern for patients with CLD undergoing surgery.
Area of Science:
- Hepatology
- Hematology
- Pharmacology
Background:
- Thrombocytopenia is the most common hematological complication of chronic liver disease (CLD), increasing with rising CLD rates.
- Portal hypertension in CLD leads to thrombocytopenia, posing bleeding risks during elective procedures common in cirrhosis management.
- Existing literature and expert guidance on managing thrombocytopenia in CLD are limited.
Purpose of the Study:
- To review current peer-reviewed literature on thrombocytopenia in patients with CLD.
- To provide expert clinical insights into the management of thrombocytopenia in CLD.
- To address the unmet need for comprehensive guidance on this topic.
Main Methods:
- Systematic review of current peer-reviewed literature on thrombocytopenia in CLD.
- Synthesis of expert clinical experience and consensus.
- Focus on thrombopoietin receptor agonists for procedural management.
Main Results:
- Thrombocytopenia is a frequent complication of CLD, impacting patient care and procedural safety.
- Thrombopoietin receptor agonists (avatrombopag, lusutrombopag) are approved and effective for increasing platelet counts in CLD patients.
- These agents have significantly improved the management of thrombocytopenia in CLD patients undergoing procedures.
Conclusions:
- New thrombopoietin receptor agonists offer effective treatment for thrombocytopenia in CLD patients.
- Expert consensus and literature review provide valuable guidance for managing this complication.
- Addressing thrombocytopenia is crucial for optimizing care and outcomes in patients with CLD.
Abstract:
Thrombocytopenia is a consequence of portal hypertension and is the most common hematological manifestation of chronic liver disease (CLD) (ie, cirrhosis). Data indicates the rates of CLD are increasing and, as a result, so will the incidence of this complication. Although bleeding risks are only relevant when elective procedures are performed, this is a frequent concern as these procedures are commonly part of the spectrum of care for patients with cirrhosis. As such, thrombocytopenia remains a pertinent issue. Fortunately, we now have effective and accurate treatment modalities to raise platelet counts before scheduled procedures, known as thrombopoietin receptor agonists. Two drugs in this therapeutic class (avatrombopag and lusutrombopag) are now approved for the treatment of thrombocytopenia in adults with CLD undergoing a procedure and have revolutionized how this is managed. Although there is progress in the field, peer-reviewed literature and expert guidance are lacking. Recognizing these unmet needs, a group of expert hepatologists comprised this review, which summarizes the most current and relevant peer-reviewed literature on thrombocytopenia in CLD and provides clinical expertise on this timely topic.
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