Abstract
BackgroundChronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count < 50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. Former studies on lusutrombopag included patients with a platelet count of > 50,000/µL at baseline: the proportions of patients who did not require platelet transfusion were 84–96%, which might be overestimated.MethodsThe efficacy and safety of lusutrombopag were retrospectively investigated in CLD patients with platelet count of < 50,000/µL, a criterion for platelet transfusion, in real-world settings. We examined the proportion of patients who did not require platelet transfusion in 31 CLD patients, which exceeded a minimum required sample size (21 patients) calculated by 80% power at a significance level of 5%. Lusutrombopag, 3 mg once daily, was administered 8–18 days before scheduled invasive procedures.ResultsAmong 31 patients who received lusutrombopag, 23 patients (74.2%) patients showed a platelet count of ≥ 50,000/µL (Group A) and did not require platelet transfusion. The remaining 8 patients (25.8%) did not reached platelet ≥ 50,000/µL (Group B). The means of platelet increase were 38,000/µL and 12,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. When all repeated uses of lusutrombopag were counted among these 13 patients, platelet transfusion was not required in 82.1% (23/28) of treatments. Although one patient showed portal thrombosis after lusutrombopag treatment, the thrombosis was disappeared by anticoagulant treatment for 35 days. The degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion.ConclusionsThe proportion of patients who did not require platelet transfusion was 74.2%, which is smaller than that in former studies which included CLD patients with a platelet count of > 50,000/µL. However, lusutrombopag is effective and safe for CLD patients with a platelet count of < 50,000/µL.
Highlights
Chronic liver disease (CLD) is often complicated by severe thrombocytopenia
Group B was characterized by a male predominance, low platelet count at baseline, platelet increase > 20,000/μL, and a high splenic volume
There were no significant differences in age, duration of lusutrombopag treatment, history of platelet transfusion, Child–Pugh grade and score, ALBI score, FIB4 index or Mac-2 binding protein glycosylation isomer, and the days from the staring lusutrombopag to the procedure between groups A and B
Summary
Chronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count < 50,000/ μL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. 10% of patients with cirrhosis show platelet counts of < 50,000/μL [2], a criterion for platelet transfusion when invasive procedures are required [3]. These patients often have hepatocellular carcinoma and gastrointestinal varices, which require invasive therapeutic procedures, including radiofrequency ablation and ligation/sclerotherapy, respectively. These invasive procedures are associated with an increased risk of bleeding events [4]. Alternative methods to platelet transfusion are required to resolve such problems
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