Thrombocytopenia in liver disease

Section editor
	Benjamin Tillman, MD Vanderbilt University Nashville, TN, USA LinkedIn

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See the thrombocytopenia reference page for general definitions and workup recommendations.

2 regimens on this page 2 variants on this page

Thrombocytopenia in liver disease with planned procedure

Avatrombopag monotherapy

Regimen

FDA-recommended dose

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Terrault et al. 2018 (ADAPT-2)	2013-2017	Phase 3 (E-esc)	Placebo	Superior primary endpoint
Terrault et al. 2018 (ADAPT-1)	2014-2017	Phase 3 (E-esc)	Placebo	Superior primary endpoint

Growth factor therapy

• Avatrombopag (Doptelet) by the following laboratory-based criteria:
  • Platelet count less than 40 x 10⁹/L: 60 mg PO once per day on days 1 to 5
  • Platelet count 40 up to 50 x 10⁹/L: 40 mg PO once per day on days 1 to 5

Procedure days were days 10 to 13

References

1. ADAPT-1: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01972529
2. ADAPT-2: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01976104

Lusutrombopag monotherapy

Regimen

FDA-recommended dose

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Alkhouri et al. 2020 (L-PLUS 1)	2013-10 to 2014-05	Phase 3 (E-esc)	Placebo	Superior primary endpoint
Alkhouri et al. 2020 (L-PLUS 2)	2015-2017	Phase 3 (E-esc)	Placebo	Superior primary endpoint

Growth factor therapy

• Lusutrombopag (Mulpleta) 3 mg PO once per day on days 1 to 7

7-day course

References

1. L-PLUS 1: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed JapicCTI-132323
2. L-PLUS 2: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed NCT02389621