Avatrombopag is an oral thrombopoetin agonist.
In May of 2018 Avatrombopag was FDA approved for use in adults with chronic liver disease undergoing a planned procedure.
The use of Avatrombopag proved to statistically reduce the need for platelet transfusion, additional procedures to manage post-op bleeding and raised platelet counts to goal of ≥ 50 x 109/L compared to placebo.
The concern for thrombosis with TPO agonists in cirrhosis has limited trials due to safety concerns.
There are limited options for CLD patients requiring frequent procedures, anti-platelet drugs or anticoagulation. The continuous use of Avatrombopag to maintain a platelet goal >50K appears both safe and effective, but does require close monitoring. It is likely that a lower dose of Avatrombopag, 20 mg, can achieve prolonged platelet support. This lower dose could play a role in reducing potential thrombotic risk. In the future a multi-center trial should be pursued.
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