Safety and Efficacy of Continuous Use Avatrombopag in Chronic Liver Disease

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.

Reference

https://doi.org/10.1182/blood-2022-165753