TY - JOUR
T1 - The efficacy and safety of thrombopoietin receptor agonists in patients with chronic liver disease undergoing elective procedures
T2 - a systematic review and meta-analysis
AU - Lindquist, Ingrid
AU - Olson, Sven R.
AU - Li, Ang
AU - Al‐Samkari, Hanny
AU - Jou, Janice
AU - McCarty, Owen J.T.
AU - Shatzel, Joseph J.
N1 - Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute [HL151367]. Authors of this work have been supported by grants from the National Institutes of Health, National Heart, Lung, and Blood Institute (HL101972, HL144113). H. Al-Samkari is the recipient of the National Hemophilia Foundation-Shire Clinical Fellowship Award, the Harvard KL2/Catalyst Medical Research Investigator Training Award, and the American Society of Hematology Scholar Award. J. Shatzel is supported by the National Institutes of Health, National Heart, Lung, and Blood Institute (HL151367).
Publisher Copyright:
© 2021 Taylor & Francis Group, LLC.
PY - 2022
Y1 - 2022
N2 - Thrombopoietin receptor agonists (TPO-RAs) can mitigate preprocedural thrombocytopenia in patients with chronic liver disease (CLD) however their effects on procedural outcomes is unclear. In this meta-analysis, we aimed to better define the efficacy, thrombotic risk and bleeding mitigation associated with the use of preoperative TPO-RAs in patients with CLD. We performed a systematic review and meta-analysis of randomized placebo-controlled clinical trials to assess the use of preprocedural TPO-RAs in patients with CLD, searching MEDLINE, EMBASE and the Cochrane library database. Six publications comprising eight randomized trials (1229 patients; 717 received TPO-RAs, 512 received placebo) and three unique TPO-RAs were retrieved. The majority of the included procedures were endoscopic. TPO-RAs were significantly more likely to result in a preoperative platelet count greater than 50 x 109/L (72.1% vs 15.6%, RR 4.8, 95% CI 3.6–6.4 p < .00001. NNT 1.8) and reduced the incidence of platelet transfusions (22.5% vs 67.8%, RR 0.33, 95% CI 0.3–0.4 p < .00001. NNT 2.2). Total periprocedural bleeding was decreased in patients who received TPO-RAs (11.6% vs 15.6%, RR 0.64, 95% CI 0.5–0.9 p = .01. NNT 24.7) and there was no increase in the rate of thrombosis (2.2% vs 1.8% RR 1.25, 95% CI 0.6–2.9 p = .60. NNH 211.1). In patients with CLD the use of preprocedural TPO-RAs resulted in significant increased platelet counts, and decreased the incidence of platelet transfusions as compared to placebo. TPO use likewise decreased the incidence of total periprocedural bleeding without increasing the rate of thrombosis.
AB - Thrombopoietin receptor agonists (TPO-RAs) can mitigate preprocedural thrombocytopenia in patients with chronic liver disease (CLD) however their effects on procedural outcomes is unclear. In this meta-analysis, we aimed to better define the efficacy, thrombotic risk and bleeding mitigation associated with the use of preoperative TPO-RAs in patients with CLD. We performed a systematic review and meta-analysis of randomized placebo-controlled clinical trials to assess the use of preprocedural TPO-RAs in patients with CLD, searching MEDLINE, EMBASE and the Cochrane library database. Six publications comprising eight randomized trials (1229 patients; 717 received TPO-RAs, 512 received placebo) and three unique TPO-RAs were retrieved. The majority of the included procedures were endoscopic. TPO-RAs were significantly more likely to result in a preoperative platelet count greater than 50 x 109/L (72.1% vs 15.6%, RR 4.8, 95% CI 3.6–6.4 p < .00001. NNT 1.8) and reduced the incidence of platelet transfusions (22.5% vs 67.8%, RR 0.33, 95% CI 0.3–0.4 p < .00001. NNT 2.2). Total periprocedural bleeding was decreased in patients who received TPO-RAs (11.6% vs 15.6%, RR 0.64, 95% CI 0.5–0.9 p = .01. NNT 24.7) and there was no increase in the rate of thrombosis (2.2% vs 1.8% RR 1.25, 95% CI 0.6–2.9 p = .60. NNH 211.1). In patients with CLD the use of preprocedural TPO-RAs resulted in significant increased platelet counts, and decreased the incidence of platelet transfusions as compared to placebo. TPO use likewise decreased the incidence of total periprocedural bleeding without increasing the rate of thrombosis.
KW - Bleeding
KW - procedures
KW - thrombopoietin
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U2 - 10.1080/09537104.2020.1859102
DO - 10.1080/09537104.2020.1859102
M3 - Review article
C2 - 33459573
AN - SCOPUS:85099593748
VL - 33
SP - 66
EP - 72
JO - Platelets
JF - Platelets
SN - 0953-7104
IS - 1
ER -