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Digestive Diseases and Sciences

, Volume 64, Issue 10, pp 2757–2768 | Cite as

Management of Thrombocytopenia in Patients with Chronic Liver Disease

  • Sammy SaabEmail author
  • Robert S. BrownJr
Review

Abstract

Background

Thrombocytopenia is the most common hematologic complication associated with chronic liver disease (CLD) with important clinical implications. While the mechanisms for thrombocytopenia are multifactorial, platelet sequestration in the spleen and decreased thrombopoietin (TPO) production are the main mechanisms in patients with CLD.

Aim

This review outlines the current treatment options for thrombocytopenia in patients with CLD, explores their limitations, and proposes a revised treatment algorithm for the management of thrombocytopenia in this patient group.

Methods

A PubMed search of the literature was undertaken with search terms focused on CLD and thrombocytopenia.

Results

Until now, the standard-of-care treatment in these patients has been the use of platelet transfusions either prophylactically or periprocedurally to control bleeding. Treatment options, such as splenic artery embolization and splenectomy, are invasive, and their utility is limited by significant complications. The US Food and Drug Administration recently approved 2 s-generation TPO-receptor agonists, avatrombopag and lusutrombopag, as safe and effective therapies for the treatment of thrombocytopenia in patients with CLD scheduled to undergo a procedure.

Conclusions

The addition of avatrombopag and lusutrombopag offers physicians an alternative to platelet transfusions in patients with CLD who have to undergo medical/dental procedures that could potentially put them at an increased risk of bleeding. There are several other drugs in the research pipeline at various stages of development, including a new class of monoclonal antibodies that can bind to and activate TPO-receptor agonists. The outlook for treatment choices for thrombocytopenia in patients with liver disease is promising.

Keywords

Chronic liver disease Cirrhosis Thrombocytopenia Thrombopoietin receptor agonists Platelets transfusion Treatment algorithm 

Notes

Acknowledgments

Assistance with research, drafting of manuscript, and editorial support was provided by BioCentric, Inc.

Author's contribution

SS and RSB were involved in study concept and design; they contributed to acquisition of data; they analyzed and interpreted the data; they contributed to critical revision of the manuscript for important intellectual content; they contributed to statistical analysis (not applicable), provided administrative, technical, or material support, and supervised the study. SS, RSB and BioCentric, Inc., drafted the manuscript.

Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA
  3. 3.UCLA Medical CenterPfleger Liver InstituteLos AngelesUSA

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