The Use of Thrombopoietin Receptor Agonists for Correction of Thrombocytopenia prior to Elective Procedures in Chronic Liver Diseases: Review of Current Evidence

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY International Journal of Hepatology Pub Date : 2016-10-09 DOI:10.1155/2016/1802932
K. Qureshi, Shyam Patel, A. Meillier
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引用次数: 27

Abstract

Patients with chronic liver diseases (CLD) undergo a range of invasive procedures during their clinical lifetime. Various hemostatic abnormalities are frequently identified during the periprocedural work-up; including thrombocytopenia. Thrombocytopenia of cirrhosis is multifactorial in origin, and decreased activity of thrombopoietin has been identified to be a major cause. Liver is an important site of thrombopoietin production and its levels are decreased in patients with cirrhosis. Severe thrombocytopenia (platelet counts < 60–75,000/µL) is associated with increased risk of bleeding with invasive procedures. In recent years, compounds with thrombopoietin receptor agonist activity have been studied as therapeutic options to raise platelet counts in CLD. We reviewed the use of Eltrombopag, Romiplostim, and Avatrombopag prior to various invasive procedures in patients with CLD. These agents seem promising in raising platelet counts before elective procedures resulting in reduction in platelet transfusions, and they also enabled more patients to undergo the procedures. However, these studies were not primarily aimed at comparing bleeding episodes among groups. Use of these agents had some adverse consequences, importantly being the occurrence of portal vein thrombosis. This review highlights the need of further studies to identify reliable methods of safely reducing the provoked bleeding risk linked to thrombocytopenia in CLD.
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慢性肝病选择性手术前使用血小板生成素受体激动剂纠正血小板减少症:当前证据综述
慢性肝病(CLD)患者在其临床生命周期中经历一系列侵入性手术。在围手术期检查中经常发现各种止血异常;包括血小板减少。肝硬化的血小板减少是多因素的,血小板生成素活性降低已被确定为一个主要原因。肝脏是产生血小板生成素的重要部位,肝硬化患者的血小板生成素水平下降。严重的血小板减少症(血小板计数< 60 - 75000 /µL)与有创手术出血风险增加相关。近年来,具有血小板生成素受体激动剂活性的化合物已被研究作为提高CLD血小板计数的治疗选择。我们回顾了在CLD患者进行各种侵入性手术之前使用依曲巴、罗米普罗斯汀和阿伐巴的情况。这些药物似乎有希望在选择性手术前提高血小板计数,从而减少血小板输注,并且它们也使更多的患者接受手术。然而,这些研究的主要目的不是比较各组之间的出血事件。使用这些药物有一些不良后果,主要是门静脉血栓的发生。这篇综述强调了进一步研究的必要性,以确定安全降低CLD中血小板减少相关诱发性出血风险的可靠方法。
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来源期刊
International Journal of Hepatology
International Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.80
自引率
0.00%
发文量
11
审稿时长
15 weeks
期刊介绍: International Journal of Hepatology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the medical, surgical, pathological, biochemical, and physiological aspects of hepatology, as well as the management of disorders affecting the liver, gallbladder, biliary tree, and pancreas.
期刊最新文献
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