Thrombocytopenia in liver disease

Abstract

To evaluate recent findings in the multifaceted pathophysiological mechanisms underlying thrombocytopenia in patients with chronic liver disease and to assess its therapeutic management. Antiplatelet antibodies, despite being observed rather frequently in patients with chronic viral liver disease, have minimal relevance in the determinism of thrombocytopenia, and antiviral treatment of the underlying liver disease does not seem to significantly affect their prevalence. Translational application of the results of studies evaluating coagulation disorders associated with liver disease seems to suggest that these may be improved by treating thrombocytopenia. Both splenectomy and partial splenic embolization are still part of the therapeutic approach to thrombocytopenia. As far as this latter technique is concerned, patient selection is fundamental, and its success likely depends upon thrombopoietin-mediated mechanisms. Eltrombopag is a promising thrombopoietic drug that proved to be able to safely increase platelet counts in patients with viral liver disease and allows the initiation of antiviral treatment. New insights into the pathophysiological mechanisms of thrombocytopenia in patients with liver disease have provided interesting clinical reflex. In these patients, novel therapies for treating thrombocytopenia seem promising, although it remains to be established whether treating thrombocytopenia may help improve liver disease-associated coagulopathy.