Treatment algorithm for thrombocytopenia in patients with chronic liver disease undergoing planned invasive procedures

Yoshiji, Hitoshi; Ueno, Yoshiyuki; Kurosaki, Masayuki; Torimura, Takuji; Hatano, Etsuro; Yatsuhashi, Hiroshi; Yamakado, Koichiro

doi:10.1111/hepr.13715

Cited by 3 publications

(11 citation statements)

References 56 publications

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“…This result demonstrated that the increase in PLT count did not induce thrombotic events even in patients with a baseline PLT count of more than 5 × 10 4 /µL. Recently, an expert opinion on a Japanese treatment algorithm for thrombocytopenia in patients with CLD undergoing planned invasive procedures was published 9 . In this algorism, for patients with thrombocytopenia and CLD whose pretreatment PLT is 5‐7 × 10 4 /µL and who are planning to undergo an invasive procedure with moderate bleeding risk, Lusutrombopag intake was strongly recommended.…”

Section: Discussionmentioning

confidence: 83%

“…Recently, an expert opinion on a Japanese treatment algorithm for thrombocytopenia in patients with CLD undergoing planned invasive procedures was published. 9 In this algorism, for patients with thrombocytopenia and CLD whose pretreatment PLT is 5-7 × 10 4 /µL and who are planning to undergo an invasive procedure with moderate bleeding risk, Lusutrombopag intake was strongly recommended. Even for patients whose pretreatment PLT is 7-10 × 10 4 /µL and who are planning to undergo liver biopsy, they mentioned Lusutrombopag was better to be administered, because liver biopsy has more severe bleeding risk compared with other procedures.…”

Section: Discussionmentioning

confidence: 99%

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Lusutrombopag has slightly stronger effects on patients with mild thrombocytopenia compared with those with severe thrombocytopenia: A multicenter propensity score matching study

Furuichi

Takeuchi

Uojima

et al. 2022

J Hepato Biliary Pancreat

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Background Lusutrombopag effectively increases platelet count in patients with severe thrombocytopenia. However, no multicenter studies analyzing the effects of Lusutrombopag on patients with mild thrombocytopenia (platelet count > 50 000/µL) have been performed. In this study, we aimed to clarify the efficacy of Lusutrombopag on these patients by unifying background factors by propensity score matching. Methods A total of 139 patients with thrombocytopenia were enrolled, and matched for age, sex, etiology, disease, treatment, liver function, renal function, peripheral blood count, and spleen index. The primary endpoint was to compare the increase in platelet count from baseline between the high‐platelet group (>50 000/µL) and the low‐platelet group (<50 000/µL) after Lusutrombopag treatment, using propensity score matching. The secondary endpoint was to clarify platelet transfusion avoidance rate and adverse events, moreover, to identify independent predictors associated with the increase in platelet count. Results The mean increase in platelet count was 67 000/μL vs 48 000/μL in all patients (high‐ vs low‐platelet group, P = .024), and 64 000/μL vs 48 000/μL (P = .12) after propensity score matching. The increase in platelet count and the platelet transfusion avoidance rate tended to be higher in the high‐platelet group. There was no significant difference between adverse events. Predictors associated with an increase in platelet count were sex, estimated glomerular filtration rate, and spleen index by multivariate analysis. Conclusion Lusutrombopag has a little stronger effect in patients with mild thrombocytopenia than those with severe thrombocytopenia and showed a more substantial effect in patients with impaired renal function and small spleen.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Lusutrombopag has slightly stronger effects on patients with mild thrombocytopenia compared with those with severe thrombocytopenia: A multicenter propensity score matching study

Furuichi

Takeuchi

Uojima

et al. 2022

J Hepato Biliary Pancreat

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“…Moreover, PLT transfusion still has potential risks[ 14 ], such as infectious diseases caused by blood transfusion, fever, allergic reactions, and hemolytic reactions. Besides, PLT transfusion has a limited effect on CLD, with PLT counts increasing by approximately 10 × 10 9 /L after transfusion[ 15 , 16 ], while PLT transfusion can increase PLT count by 30 × 10 9 /L in healthy patients[ 17 ]. In this study, 90% patients did not receive PLT transfusion, partially due to an increase in their PLT count after rhTPO treatment.…”

Section: Discussionmentioning

confidence: 99%

Recombinant human thrombopoietin treatment in patients with chronic liver disease-related thrombocytopenia undergoing invasive procedures: A retrospective study

Ding¹,

Feng²,

Sun³

et al. 2022

World J Gastrointest Surg

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BACKGROUND Chronic liver disease (CLD) related thrombocytopenia increases the risk of bleeding and poor prognosis. Many liver disease patients require invasive procedures or surgeries, such as liver biopsy or endoscopic variceal ligation, and most of them have lower platelet counts, which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders. Unfortunately, there is no defined treatment modality for CLD-induced thrombocytopenia. Recombinant human thrombopoietin (rhTPO) is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy; however, there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia. AIM To evaluate the efficacy of rhTPO in the treatment of patients with CLD-associated thrombocytopenia undergoing invasive procedures. METHODS All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021. Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia. Adverse events related to treatment, such as bleeding, thrombosis, and disseminated intravascular coagulation, were also investigated. RESULTS Among the enrolled patients, 78 (78%) showed a platelet count increase after rhTPO use, while 22 (22%) showed no significant change in platelet count. The mean platelet count after rhTPO treatment in all patients was 101.53 ± 81.81 × 10 9 /L, which was significantly improved compared to that at baseline (42.88 ± 16.72 × 10 9 /L), and this difference was statistically significant ( P < 0.001). In addition, patients were further divided into three subgroups according to their baseline platelet counts (< 30 × 10 9 /L, 30-50 × 10 9 /L, > 50 × 10 9 /L). Subgroup analyses showed that the median platelet counts after treatment were significantly higher ( P < 0.001, all). Ninety (90%) patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO. No serious adverse events related to rhTPO treatment were observed. Overall, rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia. CONCLUSION rhTPO can improve platelet count, reduce the risk of bleeding, and decrease the platelet transfusion rate, which may promote the safety of invasive procedures and improve overall survival of patients with CLD.

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“…2 However, bleeding risk is a concern in invasive procedures, particularly in CLD patients with low platelet counts. [3][4][5] Prophylactic platelet transfusion is commonly used to reduce the bleeding risk. 1,6 There are limitations associated with platelet transfusions, such as adverse reactions, short duration of effectiveness, and logistical concerns.…”

Section: Introductionmentioning

confidence: 99%

“…1,6 There are limitations associated with platelet transfusions, such as adverse reactions, short duration of effectiveness, and logistical concerns. 3,7 Lusutrombopag is a second-generation, oral thrombopoietin receptor agonist (TPORA) approved for treatment of thrombocytopenia in patients with CLD before invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

Safety and effectiveness of lusutrombopag in patients who have chronic liver disease with thrombocytopenia and undergoing invasive procedures: Real‐world post‐marketing surveillance in Japan

Yoshiji,

Suzuki,

Imasaki

et al. 2023

Hepatology Research

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AimLustrombopag has been approved for the treatment of thrombocytopenia in patients with chronic liver diseases who are scheduled to undergo an invasive procedure. Here, we report the final results of a post‐marketing surveillance assessing the safety and effectiveness of lusutrombopag in Japan.MethodsThis multicenter, prospective, real‐world surveillance collected data from case report forms between October 2016 and May 2021. The observation period was 2 months after the first day of lusutrombopag treatment. Safety and effectiveness (proportion of patients avoiding preoperative platelet transfusion and responders who achieved platelet count increase from baseline) were assessed.ResultsThe safety analysis set included 1033 (100.0%), 130 (12.6%), and 14 (1.4%) patients who received one or more, two or more, and three or more treatment cycle(s), and 482 (48.9%), 457 (46.3%), and 43 (4.4%) patients who were Child–Pugh class A, B, and C, respectively. The most common serious adverse drug reactions were portal vein thrombosis, pancytopenia, and white blood cell count decrease, reported in 14 (1.36%), three (0.29%), and two (0.19%) patients, respectively. The incidence of adverse drug reactions was not higher in patients with Child–Pugh class C or those undergoing retreatment cycles compared with other Child–Pugh classes or the first treatment cycle, respectively. During the observation period of the first treatment cycle, 94.7% (889/939) of patients avoided preoperative platelet transfusion and 82.8% (741/895) of the patients met the responder criteria.ConclusionsThis surveillance study further supports the safety and effectiveness of lusutrombopag in a broad range of patients with chronic liver diseases undergoing planned invasive procedures.Clinical Trial RegistrationJapicCTI‐163432.

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Treatment algorithm for thrombocytopenia in patients with chronic liver disease undergoing planned invasive procedures

Cited by 3 publications

References 56 publications

Lusutrombopag has slightly stronger effects on patients with mild thrombocytopenia compared with those with severe thrombocytopenia: A multicenter propensity score matching study

Lusutrombopag has slightly stronger effects on patients with mild thrombocytopenia compared with those with severe thrombocytopenia: A multicenter propensity score matching study

Recombinant human thrombopoietin treatment in patients with chronic liver disease-related thrombocytopenia undergoing invasive procedures: A retrospective study

Safety and effectiveness of lusutrombopag in patients who have chronic liver disease with thrombocytopenia and undergoing invasive procedures: Real‐world post‐marketing surveillance in Japan

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