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Updated: Aug 6, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet optimization in high-risk ALBI grade 3 patients undergoing invasive procedures: real-world evidence from
Kongcai Zhu1, Fang Xiong2, Haihong Bai1
1Department of Pharmacy, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Background:
Evidence regarding lusutrombopag use in patients with hepatocellular carcinoma (HCC) and poor hepatic reserve remains limited, particularly in ALBI grade 3 patients. This study aimed to explore peri-procedural platelet outcomes after lusutrombopag treatment in HCC patients stratified by ALBI grade, with particular attention to the ALBI grade 3 subgroup.
Methods:
We conducted a single-center retrospective study of 76 patients with HCC and thrombocytopenia who received lusutrombopag before planned procedures. Patients were stratified as ALBI grades 1-2 or ALBI grade 3. The primary endpoint was peri-procedural platelet count, defined as the platelet on the procedure day or the closest available value within a ±2-day window. Exploratory analyses included an adjusted general linear model, logistic regression for non-response, and per-protocol sensitivity analyses excluding patients who received rescue therapy.
Results:
Among 76 patients, 58 had ALBI grades 1-2 and 18 had ALBI grade 3. The primary endpoint was evaluable in 60 patients, including 46 with ALBI grades 1-2 and 14 with ALBI grade 3. Median peri-procedural platelet counts were 59.0 (50.0-69.0) × 109/L in the ALBI grades 1-2 group and 69.0 (41.8-82.8) × 109/L in the ALBI grade 3 group (p = 0.345). Responder rates were 84.5% (49/58) and 77.8% (14/18), respectively (p = 0.493). In adjusted analyses, ALBI grade 3 was not independently associated with lower peri-procedural platelet count or non-response after accounting for baseline platelet count and relevant covariates. Per-protocol sensitivity analyses yielded directionally similar findings. No bleeding or thrombotic events were observed in the ALBI grade 3 group, although safety analyses were descriptive.
Conclusion:
In this selected real-world HCC cohort, ALBI grade 3 was not independently associated with lower peri-procedural platelet count after lusutrombopag treatment. These findings are exploratory and should not be interpreted as evidence of equivalent efficacy or established safety across ALBI strata. Larger prospective studies are needed to validate these results.
