Thrombocytopenia in liver disease

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

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Regimen

FDA-recommended dose

Study	Evidence	Comparator	Comparative Efficacy
Terrault et al. 2018 (ADAPT-1/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

1. 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

Lusutrombopag monotherapy

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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

1. CT.gov

Placebo

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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

1. 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