Difference between revisions of "Thrombocytopenia in liver disease"
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!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | !style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
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| − | |[https://www.gastrojournal.org/article/S0016-5085(18)34545-1/fulltext Terrault et al. 2018 (ADAPT-1/ADAPT-2)] | + | |[https://www.gastrojournal.org/article/S0016-5085(18)34545-1/fulltext Terrault et al. 2018 (ADAPT-1)] |
| + | | style="background-color:#1a9851" |Phase III (E-esc) | ||
| + | |[[#Placebo|Placebo]] | ||
| + | | style="background-color:#1a9850" |Superior primary endpoint | ||
| + | |- | ||
| + | |[https://www.gastrojournal.org/article/S0016-5085(18)34545-1/fulltext Terrault et al. 2018 (ADAPT-2)] | ||
| style="background-color:#1a9851" |Phase III (E-esc) | | style="background-color:#1a9851" |Phase III (E-esc) | ||
|[[#Placebo|Placebo]] | |[[#Placebo|Placebo]] | ||
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'''Procedure days were days 10 to 13''' | '''Procedure days were days 10 to 13''' | ||
===References=== | ===References=== | ||
| − | # '''ADAPT-1/ADAPT-2:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 May 17. | + | # '''ADAPT-1:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://www.gastrojournal.org/article/S0016-5085(18)34545-1/fulltext link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01972529 |
| + | # '''ADAPT-2:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://www.gastrojournal.org/article/S0016-5085(18)34545-1/fulltext link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01976104 | ||
==Lusutrombopag monotherapy {{#subobject:8f4acd|Regimen=1}}== | ==Lusutrombopag monotherapy {{#subobject:8f4acd|Regimen=1}}== | ||
Revision as of 12:13, 9 June 2021
| Section editor | |
|---|---|
 |
Benjamin Tillman, MD Vanderbilt University Nashville, TN |
See the thrombocytopenia reference page for general definitions and workup recommendations.
2 regimens on this page
2 variants on this page
|
Thrombocytopenia in liver disease with planned procedure
Avatrombopag monotherapy
| back to top |
Regimen
| FDA-recommended dose |
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| Terrault et al. 2018 (ADAPT-1) | Phase III (E-esc) | Placebo | Superior primary endpoint |
| Terrault et al. 2018 (ADAPT-2) | Phase III (E-esc) | Placebo | Superior primary endpoint |
Growth factor therapy
- Avatrombopag (Doptelet) as follows:
- Platelet count less than 40 x 109/L: 60 mg PO once per day on days 1 to 5
- Platelet count at least 40 and less than 50 x 109/L: 40 mg PO once per day on days 1 to 5
Procedure days were days 10 to 13
References
- ADAPT-1: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01972529
- ADAPT-2: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01976104
Lusutrombopag monotherapy
| back to top |
Regimen
| FDA-recommended dose |
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| (L-PLUS 1/L-PLUS 2) | Phase III (E-esc) | Placebo | Superior primary endpoint |
Note: there are no apparent publications of these trials, to date.
Growth factor therapy
- Lusutrombopag (Mulpleta) 3 mg PO once per day on days 1 to 7
7-day course
References
Placebo
| back to top |
Regimen
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| Terrault et al. 2018 (ADAPT-1/ADAPT-2) | Phase III (C) | Avatrombopag | Inferior primary endpoint |
| (L-PLUS 1/L-PLUS 2) | Phase III (C) | Lusutrombopag | Inferior primary endpoint |
No active treatment.
References
- ADAPT-1/ADAPT-2: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 May 17. [Epub ahead of print] link to original article PubMed