Management of Thrombocytopenia in Chronic Liver Disease: Focus on Pharmacotherapeutic Strategies.
Thrombocytopenia (platelet count <150 × 10(9)/L) often complicates chronic liver disease, impeding optimal management of these patients. The prevalence of this manifestation ranges from 6% among non-cirrhotic patients with chronic liver disease to 70% among patients with liver cirrhosis. It has also been shown that the severity of liver disease is associated with both prevalence and level of thrombocytopenia. Its development is often multifactorial, although thrombopoietin is thought to be a major factor. The discovery of and ability to clone thrombopoietin led to new treatment opportunities for this clinical manifestation. This review discusses data on the three most important thrombopoietin receptor agonists: eltrombopag, avatrombopag, and romiplostim. Currently, only eltrombopag is approved for usage among patients with thrombocytopenia and chronic hepatitis C virus infection in order to initiate and maintain interferon-based antiviral treatment. Nevertheless, the optimal management of hematologic abnormalities among patients with chronic liver disease, and its risk for bleeding complications, is still a matter of discussion. Thrombocytopenia definitely contributes to hemostatic defects but is often counterbalanced by the enhanced presence of procoagulant factors. Therefore, a thorough assessment of the patient's risk for thrombotic events is essential when the use of thrombopoietin receptor agonists is considered among patients with chronic liver disease and thrombocytopenia.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 206, 3015 CE, Rotterdam, The Netherlands. r.maan@erasmusmc.nl.
Raoel
R
Maan
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 206, 3015 CE, Rotterdam, The Netherlands. r.deknegt@erasmusmc.nl.
Robert J
RJ
de Knegt
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 206, 3015 CE, Rotterdam, The Netherlands. B.Veldt@rdgg.nl.
Bart J
BJ
Veldt
D001565:Benzoates / Q000627:therapeutic use*; D002908:Chronic Disease; D019468:Disease Management; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D008107:Liver Diseases / Q000150:complications*; D011720:Pyrazoles / Q000627:therapeutic use*; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013844:Thiazoles / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000150:complications* / Q000188:drug therapy*; D013926:Thrombopoietin / Q000627:therapeutic use*
D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013844:Thiazoles; D013876:Thiophenes; C533238:avatrombopag; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag