Efficacy of Repeated Lusutrombopag Administration for Thrombocytopenia in a Patient Scheduled for Invasive Hepatocellular Carcinoma Treatment

Abstract

The efficacy of repeated lusutrombopag administration for thrombocytopenia in patients with chronic liver disease who undergo two or more planned invasive procedures is unknown. We herein report our findings regarding the effects of repeated lusutrombopag administration given to avoid platelet transfusion in a patient with chronic liver disease and thrombocytopenia. The platelet count showed a positive response to lusutrombopag treatment prior to the initial invasive procedure to treat a hepatoma, so platelet transfusion was not necessary. In conclusion, lusutrombopag may be a useful drug for patients with thrombocytopenia to avoid platelet transfusion in those undergoing two or more planned invasive procedures.

Thrombocytopenia and Procedural Prophylaxis in the Era of Thrombopoietin Receptor Agonists

“…(42) It has been used frequently in Japan in patients with cirrhosis with thrombocytopenia undergoing partial splenic embolization (43) and locoregional treatment of HCC, (44)(45)(46)(47) and case reports suggest efficacy and safety of repeated courses 3-4 months apart. (44,45) In the United States, lusutrombopag was also approved for use in patients with advanced liver disease in whom an elective procedure is planned, based on two randomized, double-blind, placebo-controlled clinical trials (the L-PLUS-1 and L-PLUS-2). (48,49) These studies demonstrated the efficacy of lusutrombopag in increasing platelet count and reducing the need for platelet transfusions in patients with chronic liver disease and thrombocytopenia undergoing invasive procedures.…”

“…The newest agent available in the United States is lusutrombopag (Mulpleta), which has been used in Japan since 2015 to increase platelet counts in patients with advanced liver disease . It has been used frequently in Japan in patients with cirrhosis with thrombocytopenia undergoing partial splenic embolization and locoregional treatment of HCC, and case reports suggest efficacy and safety of repeated courses 3‐4 months apart …”

“…(40) The newest agent available in the United States is lusutrombopag (Mulpleta), which has been used in Japan since 2015 to increase platelet counts in patients with advanced liver disease. (42) It has been used frequently in Japan in patients with cirrhosis with thrombocytopenia undergoing partial splenic embolization (43) and locoregional treatment of HCC, (44)(45)(46)(47) and case reports suggest efficacy and safety of repeated courses 3-4 months apart. (44,45) In the United States, lusutrombopag was also approved for use in patients with advanced liver disease in whom an elective procedure is planned, based on two randomized, double-blind, placebo-controlled clinical trials (the L-PLUS-1 and L-PLUS-2).…”

Role of severe thrombocytopenia in preventing platelet count recovery in thrombocytopenic patients with chronic liver disease

“…1,2 Platelets play an important role in hemostasis; of the three categories of thrombocytopenia, 2 patients with mild (75-150 × 10 3 platelets/μL) or moderate (50-75 × 10 3 platelets/μL) conditions may still proceed with invasive treatments, 3 while those with severe thrombocytopenia (< 50 × 10 3 platelets/μL) are unable to undergo invasive procedures because of the risk of spontaneous bleeding. 1,2 Platelets play an important role in hemostasis; of the three categories of thrombocytopenia, 2 patients with mild (75-150 × 10 3 platelets/μL) or moderate (50-75 × 10 3 platelets/μL) conditions may still proceed with invasive treatments, 3 while those with severe thrombocytopenia (< 50 × 10 3 platelets/μL) are unable to undergo invasive procedures because of the risk of spontaneous bleeding.…”

Lusutrombopag as pretreatment for liver biopsy following liver transplantation

“…Lusutrombopag was recently covered by insurance, in December 2015 in Japan. There are still few articles on lusutrombopag . Additionally, there is no report on the use of lusutrombopag in pediatric patients.…”