Thrombocytopenia in liver disease

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See the thrombocytopenia reference page for general definitions and workup recommendations.
Last updated on 2024-07-23:2 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 	Higher proportion of patients not requiring platelet transfusions or rescue procedures for bleeding up to 7 days after a scheduled procedure (primary endpoint)
Terrault et al. 2018 (ADAPT-1)	2014-2017 	Phase 3 (E-esc)	Placebo 	Higher proportion of patients not requiring platelet transfusions or rescue procedures for bleeding up to 7 days after a scheduled procedure (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===
# 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 EuroPMC NCT01972529
# 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 EuroPMC 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 	Lower requirement for platelet transfusion before the invasive procedure and rescue therapies for bleeding 7 days or fewer after the invasive procedure (primary endpoint)Endpoint: 32% vs 91.1%
Alkhouri et al. 2020 (L-PLUS 2)	2015-2017 	Phase 3 (E-esc)	Placebo 	Lower requirement for platelet transfusion before the invasive procedure and rescue therapies for bleeding 7 days or fewer after the invasive procedure (primary endpoint)
====Growth factor therapy====
*Lusutrombopag (Mulpleta) 3 mg PO once per day on days 1 to 7
7-day course
===References===
# 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 EuroPMC JapicCTI-132323
# 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 EuroPMC NCT02389621
Category:Thrombocytopenia in liver disease regimens
Category:Disease-specific pages
Category:Cytopenias