Treatment of thrombocytopenia with thrombopoietin receptor agonists (TPORAs) seems to be associated with portal vein thrombosis (PVT) in patients with chronic liver disease (CLD). We performed a meta-analysis of the trials carried out in this clinical setting to assess if such association is detectable.
We performed a meta-analysis with studies that compared the effect of TPORAS vs placebo in patients with CLD and thrombocytopenia.
Four studies, including 1953 patients, reported the incidence of PVT in patients with CLD and thrombocytopenia treated with TPORAs or placebo. No significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.8; 95% C.I., 0.97–8.16; p = 0.055). A significant association between PVT and TPORAs was observed only in patients treated with eltrombopag (O.R.: 3.8; 95% C.I., 1.14–13.2; p = 0.03). Three studies, including 514 patients who were undergoing an elective invasive procedure, analyzed the incidence of PVT in TPORAs—treated patients with CLD and thrombocytopenia; no significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.6; 95% C.I., 0.6–11.6; p = 0.212). A significant difference was found for incidence of arterial and venous thrombo-embolic events in CLD patients treated with eltrombopag compared with placebo-treated patients (O.R.: 3.4; 95% C.I., 1.5–7.7; p = 0.003).
The results of this meta-analysis show that TPORAs are not associated with PVT in CLD patients even in the case of surgical procedure. PVT risk seems to be associated only with eltrombopag use.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management.Hepatology. 2006; 44: 1039-1046
- Thrombocytopenia associated with chronic liver disease.J Hepatol. 2008; 48: 1000-1007
- Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction.J Hepatol. 2011; 55: 1415-1427
- Platelet count does not predict bleeding in cirrhotic patients: results from the pro-liver study.Am J Gastroenterol. 2018; 113: 368-375
- Thrombopoietin receptor agonists significantly increase the risk of portal vein thrombosis in liver diseases: meta-analysis of RCTs.Thromb Haemost. 2015; 113: 1378-1380
- Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia.N Engl J Med. 2012; 367: 716-724
- A phase 3, randomized, double-blind, placebo-controlled study of lusutrombopag for thrombocytopenia in patients with chronic liver disease undergoing elective invasive procedures in Japan (L-PLUS 1).Hepatology. 2018; 62: 1397A-1398A
- Eltrombopag increases platelet numbers in thrombocytopenic patients with HCV infection and cirrhosis, allowing for effective antiviral therapy.Gastroenterology. 2014; 146 (e1): 442-452
- Phase II study of avatrombopag in thrombocytopenic patients with cirrhosis undergoing an elective procedure.J Hepatol. 2014; 61: 1253-1259
- Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia.N Engl J Med. 2012; 367: 2056
Published online: June 20, 2018
Accepted: June 8, 2018
Received: May 20, 2018
© 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.