Chronic liver disease, thrombocytopenia and procedural bleeding risk; are novel thrombopoietin mimetics the solution?

Sven R. Olson, Steven Koprowski, Justine Hum, Owen McCarty, Thomas Deloughery, Joseph J. Shatzel

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Chronic liver disease (CLD) alters normal hemostatic and thrombotic systems via multiple mechanisms including reduced platelet function and number, leading to challenging peri-operative planning. Hepatic thrombopoietin (TPO) synthesis is reduced in CLD, leading to several recent randomized, placebo-controlled trials examining the utility of TPO-mimetics to increase platelet counts prior to surgery. While these trials do suggest that TPO-mimetics are efficacious at increasing platelet counts in patients with CLD and have led to several recent drug approvals in this space by the U.S. Food & Drug Administration, it remains unclear whether these results translate to the relevant clinical endpoint of reduced perioperative bleeding rate and severity. In this article, we review several recently-published, phase 3 trials on the TPO-mimetics eltrombopag, avatrombopag and lusutrombopag, and discuss the clinical significance of their results.

Original languageEnglish (US)
JournalPlatelets
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Bleeding
  • Platelets
  • thrombopoietin

ASJC Scopus subject areas

  • Hematology

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