Thrombocytopenia in liver disease
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| Page editor | Section editor | ||
|---|---|---|---|
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Ronak H. Mistry, DO Vanderbilt University Nashville, TN  @rmistry91
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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
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Thrombocytopenia in liver disease with planned procedure
Avatrombopag monotherapy
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Regimen
| FDA-recommended dose |
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Terrault et al. 2018 (ADAPT-2) | 2013-2017 | Phase III (E-esc) | Placebo | Superior primary endpoint |
| Terrault et al. 2018 (ADAPT-1) | 2014-2017 | 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
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Regimen
| FDA-recommended dose |
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Alkhouri et al. 2020 (L-PLUS 1) | 2013-2014 | Phase III (E-esc) | Placebo | Superior primary endpoint |
| Alkhouri et al. 2020 (L-PLUS 2) | 2015-2017 | Phase III (E-esc) | Placebo | Superior primary endpoint |
Growth factor therapy
- Lusutrombopag (Mulpleta) 3 mg PO once per day on days 1 to 7
7-day course
References
- L-PLUS 1: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed JapicCTI-132323
- L-PLUS 2: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed NCT02389621
Placebo
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Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Alkhouri et al. 2020 (L-PLUS 1) | 2013-2014 | Phase III (C) | Lusutrombopag | Inferior primary endpoint |
| Terrault et al. 2018 (ADAPT-2) | 2013-2017 | Phase III (C) | Avatrombopag | Inferior primary endpoint |
| Terrault et al. 2018 (ADAPT-1) | 2014-2017 | Phase III (C) | Avatrombopag | Inferior primary endpoint |
| Alkhouri et al. 2020 (L-PLUS 2) | 2015-2017 | 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 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed
- L-PLUS 1: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed JapicCTI-132323
- L-PLUS 2: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed NCT02389621