Abstract
Background
Severe thrombocytopenia in cirrhosis can preclude invasive procedures. Platelet transfusion
is recommended if platelet count pre-procedure is potential alternative to platelet
transfusion is thrombopoietin-receptor (TPO) agonists.
Aim
Evaluate TPO-agonist efficacy and safety in cirrhotic patients with severe thrombocytopenia
undergoing invasive procedures.
Methods
Randomized control trials (RCT) from electronic reference databases were searched
from inception till December 2019. PRISMA guidelines were followed. Primary outcome
was platelet transfusion avoidance. Secondary outcomes were weighted mean difference
(WMD) in platelet count from baseline to pre-procedure and rates of major adverse
events (AE). Pooled Odds Ratio (OR) were estimated using a random-effects model.
Results
Six RCTs with 1,229 patients were included. All studies had low risk of bias.
Compared with placebo, those treated with TPO-agonists had a pooled OR of 0.12(0.08-0.17),
P<0.01 for platelet transfusion avoidance, and WMD in platelet count (x10 3 /µL) of
35.6(28.6-42.7), P<0.01. Major AE did not differ between groups [Pooled OR: 0.87(0.47–1.62),
P=0.66].
Conclusion
Compared to placebo, TPO-agonists used in cirrhotic patients with severe thrombocytopenia
prior to elective invasive procedures had 88% reduced odds of requiring peri-procedural
platelet transfusion and increased platelet count pre-procedure, with no difference
in AE rates.
Keywords
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Article info
Publication history
Published online: August 07, 2021
Accepted:
July 19,
2021
Received in revised form:
July 16,
2021
Received:
June 3,
2021
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Implementing pre-procedural thrombopoietin receptor agonists in cirrhotic patients with severe thrombocytopenia: Indiscriminate, selective or unneeded?Digestive and Liver DiseaseVol. 53Issue 11
- PreviewRecent studies promote thrombopoietin-receptor agonists (TRAs), instead of platelet transfusions, before elective invasive procedures in patients with cirrhosis and platelet count below 50 × 109/L [1–6] to prevent procedure-related bleeding. In the current issue of Digestive and Liver Disease the systematic review and meta-analysis by Rose and colleagues [7] confirms that TRAs significantly decrease the amount of the supposed required platelet transfusions. At variance with platelet transfusions, which have a slight and short-term effect on the platelet count, second generation TRAs more often achieve a predictable and persistent increase of the platelet count above the conventional threshold of 50 × 109/L, thus allegedly providing higher protection against peri‑procedural and delayed bleeding.
- Full-Text
- Preview
- Erratum to: “Pre-procedural use of thrombopoietin-receptor agonists in cirrhosis and severe thrombocytopenia: A systematic review and meta-analysis” [Dig. Liver Dis. 2021;53:1396–1403]Digestive and Liver DiseaseVol. 54Issue 1
