Management of thrombocytopenia due to liver cirrhosis: A review

Abstract

Thrombocytopenia is a common complication in liver disease and can adversely affect the treatment of liver cirrhosis, limiting the ability to administer therapy and delaying planned surgical/diagnostic procedures because of an increased risk of bleeding. Multiple factors, including splenic sequestration, reduced activity of the hematopoietic growth factor thrombopoietin, bone marrow suppression by chronic hepatitis C virus infection and anti-cancer agents, and antiviral treatment with interferon-based therapy, can contribute to the development of thrombocytopenia in cirrhotic patients. Of these factors, the major mechanisms for thrombocytopenia in liver cirrhosis are (1) platelet sequestration in the spleen; and (2) decreased production of thrombopoietin in the liver. Several treatment options, including platelet transfusion, interventional partial splenic embolization, and surgical splenectomy, are now available for severe thrombocytopenia in cirrhotic patients. Although thrombopoietin agonists and targeted agents are alternative tools for noninvasively treating thrombocytopenia due to liver cirrhosis, their ability to improve thrombocytopenia in cirrhotic patients is under investigation in clinical trials. In this review, we propose a treatment approach to thrombocytopenia according to our novel concept of splenic volume, and we describe the current management of thrombocytopenia due to liver cirrhosis.

A randomized controlled trial of lusutrombopag in Japanese patients with chronic liver disease undergoing radiofrequency ablation

“…In patients with severe thrombocytopenia and levels below 50 × 10 3 /µL, thrombocytopenia represents an obstacle for invasive diagnostic or therapeutic procedures [1, 3]. Multiple factors are thought to contribute to the development of thrombocytopenia in CLD patients.…”

“…However, there are several limitations and potential complications associated with platelet transfusions, including febrile nonhemolytic and allergic reactions, risk of infection and platelet refractoriness, need for hospitalization, and high cost [4–7]. Alternatives that are more permanent and less common than repeat of platelet transfusions for patients with CLD and severe resistant thrombocytopenia are procedures such as splenectomy or splenic artery embolization [2, 3, 8, 9]. However, concerns remain regarding the long-term outcomes of splenectomy and its impact on immunological function as well as the morbidity associated with procedure-related complications [10].…”

Safety and effectiveness of lusutrombopag in Japanese chronic liver disease patients with thrombocytopenia undergoing invasive procedures: Interim results of a postmarketing surveillance

“…In Japan, causes of liver cirrhosis include chronic infection with hepatitis C (60.9%) or hepatitis B (13.9%) viruses, alcohol consumption (13.6%), primary biliary cirrhosis (2.4%), non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis (2.1%), and autoimmune hepatitis (1.9%) . Thrombocytopenia, which is defined as moderate or severe if platelet levels are ≥50 to <100 × 10 9 /L or < 50 × 10 9 /L, respectively, is a common hematological disorder in patients with CLD …”

The clinical and economic burden of patients with chronic liver disease and thrombocytopaenia receiving platelet transfusions during planned invasive procedures

“…Thrombocytopaenia may be caused by multiple factors including reduced platelet production due to decreased production of thrombopoietin, splenic sequestration of platelets and increased platelet destruction . Patients with cirrhosis and other decompensated CLD are at a higher risk for thrombocytopaenia; one review of management of thrombocytopaenia in this population suggests that up to 78% of patients with cirrhosis have thrombocytopaenia …”