Category: Professional Posters
Purpose: Thrombocytopenia is common in patients with cirrhosis, affecting up to 84% of patients and worsens with the degree of cirrhosis. Invasive procedures are often deferred due to the risk of life threatening bleeding and the requirement of transfusion blood products. Avatrombopag is a thrombopoietin receptor agonist molecule that mimics the biological effects of thrombopoietin. The ADAPT studies concluded that avatrombopag can increase platelet counts by 91 -102 percent. The objective of the study is to evaluate the efficacy of avatrombopag in thrombocytopenic patients requiring elective endoscopic procedures.
Methods: This is a single center, retrospective, observational study to evaluate the efficacy of avatrombopag in increasing platelet count before and after elective procedures. Data was collected using the electronic medical records for patients undergoing procedures and treated with avatrombopag from July 2018 to March 2019. All data was recorded confidentially and de-identified. The primary endpoint was the percentage increase in platelet count. Secondary endpoints included assessment of bleeding and the requirement of a transfusion.
Results: A total of 5 patients and 8 incidences were included in the study undergoing the following procedures: upper endoscopy, liver biopsy, chemoembolization, and radiofrequency ablation. Patients were given 40 mg once daily for 5 days (x=5) or 60 mg once daily for 5 days (x=3). The average pre-avatrombopag platelet count was 44.3 K/uL. The average post avatrombopag platelet count was 80.6 K/uL. The average increase of platelet count for patients that received 40 mg and 60 mg of avatrombopag were 67% and 133%, respectively. The average increase of platelet count for all incidences was 92%. None of these patients required a transfusion of blood products. The average hemoglobin prior to procedures was 12.2 g/dL and 12.3 g/dL post treatment.
Conclusion: Avatrombopag was effective in the treatment of thrombocytopenia prior to elective procedures. There was no change in patients’ hemoglobin count and no adverse events reported. All patients who received avatrombopag were able to have their procedures performed without major adverse events or the requirement of platelet transfusions. The use of avatrombopag can be advantageous in preventing the need for platelet transfusions. Thrombopoietin receptor agonists can allow patients to undergo procedures that may have been otherwise deferred.