Avatrombopag and Platelet Recovery in Sepsis-Associated Thrombocytopenia: A Retrospective Observational Cohort Study

BackgroundSepsis-associated thrombocytopenia (SAT) is a common complication in critically ill patients and is associated with increased disease severity and adverse outcomes. Platelet transfusion is the main supportive therapy but provides limited and transient benefit. Evidence regarding thrombopoietin-receptor agonists in SAT remains scarce.ObjectivesTo evaluate the association between avatrombopag administration and platelet recovery, clinical outcomes, and safety in critically ill patients with SAT.MethodsWe conducted a single-center, retrospective observational cohort study of adult ICU patients with SAT between May 2022 and May 2024. Patients were categorized according to avatrombopag exposure during the ICU stay. The primary outcome was platelet recovery at day 14. Secondary outcomes included platelet recovery at days 7 and 10, 28-day mortality, and ICU length of stay. Confounding was addressed using propensity score-based inverse probability of treatment weighting (IPTW). Associations were assessed using weighted regression models, with prespecified sensitivity and subgroup analyses.ResultsAmong 256 included patients, 119 received avatrombopag and 137 did not. After IPTW adjustment, avatrombopag use was independently associated with higher odds of platelet recovery at day 14 (odds ratio 3.58, 95% confidence interval 1.31-9.79). No consistent benefit was observed for early platelet recovery at day 7 or day 10. Avatrombopag use was not associated with reduced 28-day mortality. Rates of bleeding and thrombotic events were similar between groups. However, avatrombopag exposure was consistently associated with a longer ICU length of stay. Subgroup analyses suggested greater platelet recovery benefit in patients with higher platelet transfusion requirements and greater illness severity.ConclusionsIn critically ill patients with SAT, avatrombopag administration was associated with improved delayed platelet recovery without increased bleeding or thrombotic risk. This hematologic benefit did not translate into improved short-term survival and was accompanied by prolonged ICU stay.