Drugs & Therapy Perspectives

, Volume 35, Issue 1, pp 1–6 | Cite as

Avatrombopag in the treatment of thrombocytopenia in adults with chronic liver disease scheduled to undergo a procedure: a profile of its use in the USA

  • Emma H. McCaffertyEmail author
  • Katherine A. Lyseng-Williamson
Adis Drug Q&A


Avatrombopag (Doptelet®) is the first thrombopoietin receptor agonist approved in the USA to treat thrombocytopenia in adults with chronic liver disease who are scheduled to undergo a procedure. It is an important new development to mitigate the risk of bleeding and improve post-procedure management in this patient population. Relative to placebo, oral avatrombopag significantly increased the proportion of patients who did not require a platelet transfusion or rescue procedure up to 7 days after the scheduled procedure. Its efficacy was not altered by the bleeding risk associated with the procedure, or by patient age, sex, race, or degree of hepatic impairment. Avatrombopag has a convenient 5-day oral administration regimen and is well tolerated.



The manuscript was reviewed by: V.G.R. Gangireddy, United Hospital Center, Bridgeport, WV, USA; N.S. Reau, Rush Medical College, Chicago, IL, USA; B.B. Weksler, Division of Hematology-Medical Oncology, Weill Cornell Medicine, New York, NY, USA. During the peer review process, Dova Pharmaceuticals, the marketing-authorization holder of avatrombopag (Doptelet®), was also offered an opportunity to provide a scientific accuracy review of their data. Changes resulting from comments received were made on the basis of scientific and editorial merit.

Compliance with Ethical Standards


The preparation of this review was not supported by any external funding.

Conflict of interest

E.H. McCafferty and K.A. Lyseng-Williamson are employees of Adis, are responsible for the article content and declare no conflicts of interest.


  1. 1.
    National Heart, Lung, and Blood Institute. Thrombocytopenia. Bethesda (MD): National Heart, Lung, and Blood Institute; 2018.Google Scholar
  2. 2.
    Mitchell O, Feldman DM, Diakow M, et al. The pathophysiology of thrombocytopenia in chronic liver disease. Hepat Med. 2016;8:39–50.Google Scholar
  3. 3.
    Kuter DJ. The biology of thrombopoietin and thrombopoietin receptor agonists. Int J Hematol. 2013;98(1):10–23.CrossRefGoogle Scholar
  4. 4.
    Afdhal N, McHutchison J, Brown R, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008;48(6):1000–7.CrossRefGoogle Scholar
  5. 5.
    Giannini EG, Greco A, Marenco S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol. 2010;8(10):899–902.CrossRefGoogle Scholar
  6. 6.
    Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8(10):877–83.CrossRefGoogle Scholar
  7. 7.
    Poordad F. Review article: thrombocytopenia in chronic liver disease. Aliment Pharmacol Ther. 2007;26(Suppl 1):5–11.CrossRefGoogle Scholar
  8. 8.
    Nplate® (romiplostim) for injection, for subcutaneous use: US prescribing information. Thousand Oaks (CA): Amgen, Inc.; 2017.Google Scholar
  9. 9.
    Promacta® (eltrombopag) tablets: US prescribing information. East Hanover (NJ): Novartis Pharmaceuticals Corporation; 2018.Google Scholar
  10. 10.
    Afdhal NH, Giannini EG, Tayyab G, et al. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia. N Engl J Med. 2012;367(8):716–24.CrossRefGoogle Scholar
  11. 11.
    Doptelet® (avatrombopag) tablets: US prescribing information. Durham (NC): Dova Pharmaceuticals; 2018.Google Scholar
  12. 12.
    Fukushima-Shintani M, Suzuki K, Iwatsuki Y, et al. AKR-501 (YM477) a novel orally-active thrombopoietin receptor agonist. Eur J Haematol. 2009;82(4):247–54.CrossRefGoogle Scholar
  13. 13.
    Fukushima-Shintani M, Suzuki K, Iwatsuki Y, et al. AKR-501 (YM477) in combination with thrombopoietin enhances human megakaryocytopoiesis. Exp Hematol. 2008;36(10):1337–42.CrossRefGoogle Scholar
  14. 14.
    Terrault N, Chen Y-C, Izumi N, et al. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018;155(3):705–18.CrossRefGoogle Scholar
  15. 15.
    Michelson AD, Smolensky Koganov E, Forde EE, et al. Avatrombopag increases platelet count but not platelet activation in patients with thrombocytopenia resulting from liver disease. J Thromb Haemost. 2018;16:1–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Emma H. McCafferty
    • 1
    Email author
  • Katherine A. Lyseng-Williamson
    • 1
  1. 1.SpringerAucklandNew Zealand

Personalised recommendations