Thrombocytopenia in liver disease

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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


Thrombocytopenia in liver disease with planned procedure

Avatrombopag monotherapy

Regimen

FDA-recommended dose
Study Years of enrollment Evidence Comparator Comparative Efficacy
Terrault et al. 2018 (ADAPT-2) 2013-2017 Phase 3 (E-esc) Placebo Superior primary endpoint
Terrault et al. 2018 (ADAPT-1) 2014-2017 Phase 3 (E-esc) Placebo Superior primary endpoint

Growth factor therapy

  • Avatrombopag (Doptelet) by the following laboratory-based criteria:
    • 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: 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
  2. 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

Regimen

FDA-recommended dose
Study Years of enrollment Evidence Comparator Comparative Efficacy
Alkhouri et al. 2020 (L-PLUS 1) 2013-2014 Phase 3 (E-esc) Placebo Superior primary endpoint
Alkhouri et al. 2020 (L-PLUS 2) 2015-2017 Phase 3 (E-esc) Placebo Superior primary endpoint

Growth factor therapy

7-day course

References

  1. 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
  2. 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

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Alkhouri et al. 2020 (L-PLUS 1) 2013-2014 Phase 3 (C) Lusutrombopag Inferior primary endpoint
Terrault et al. 2018 (ADAPT-2) 2013-2017 Phase 3 (C) Avatrombopag Inferior primary endpoint
Terrault et al. 2018 (ADAPT-1) 2014-2017 Phase 3 (C) Avatrombopag Inferior primary endpoint
Alkhouri et al. 2020 (L-PLUS 2) 2015-2017 Phase 3 (C) Lusutrombopag Inferior primary endpoint

No active treatment.

References

  1. 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
  2. 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
  3. 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
  4. 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