Real-life experience with avatrombopag

Abstract

Background: Platelet transfusion is the standard of care for managing thrombocytopenia in patients with advanced liver disease undergoing procedures. Randomized control trials have demonstrated the safety and efficacy of avatrombopag in the management of thrombocytopenia in this population. However, real-world data is limited. Methods: Retrospective cohort study performed in patients 18 and older with thrombocytopenia and liver disease who were prescribed avatrombopag before invasive procedure. Patients were stratified by platelet count into high (>40.0×10 9 /L) and low baseline (<40.0×10 9 /L) cohorts. Demographic, clinical data, changes in platelet count, use of platelet transfusion, rescue therapy, and incidence of portal vein thrombosis were recorded. Results: Of the 29 study patients, 59% were male and the mean age was 62 years. Hepatitis C virus infection was the most common etiology of liver disease (28%) and esophagogastroduodenoscopy was the most common procedure performed (86%). Mean baseline platelet count was 39.3×10 9 /L and 16 patients had platelet counts below 40.0×10 9 /L. Platelet count increased 2.2 folds, from 37.4×10 9 /L to 76.9×10 9 /L in 20 patients who had peri-procedure platelet counts. No patients required rescue therapy or platelet transfusion and there were no adverse effects. There was no new portal vein thrombosis. Conclusions: Results from this real-world study are consistent with the results of the clinical trials for avatrombopag. Avatrombopag is a safe and effective alternative to platelet transfusion to treat thrombocytopenia in patients with chronic liver disease scheduled to undergo a procedure. Our primary outcome assessed efficacy as defined as the proportion of patients who did not require a platelet transfusion or rescue procedure for bleeding up to 7 days after a procedure. Secondary end points assessed adverse events as defined as the proportion of patients with adverse events and proportion of patients who developed portal vein thrombosis after receiving avatrombopag. Sensitivity analysis was performed on platelet response to avatrombopag.