Efficacy and Safety of Avatrombopag in Patients with Chronic Liver Disease and Thrombocytopenia Undergoing Elective Surgery.

Background/Objectives: The aim of this study was to evaluate the efficacy and safety of avatrombopag in patients with chronic liver disease (CLD) and thrombocytopenia scheduled for elective invasive/minimally invasive procedures, providing clinical guidance for patients requiring platelet (PLT) elevation. Methods: In this single-center, prospective study, patients with CLD and PLT counts <50 × 109/L were scheduled for elective invasive/minimally invasive surgery, receiving 5-day avatrombopag plus standard CLD management. PLT response, dynamics, and safety were assessed. Results: A total of 108 patients with CLD and baseline PLT counts <50 × 109/L were enrolled, showing an 83.33% response rate. Responders exhibited significantly higher baseline white blood cell (WBC, p = 0.009), neutrophil (p = 0.016), hemoglobin (HGB, p = 0.011), and PLT (p = 0.001) levels compared to non-responders. Baseline PLT correlated positively with age (p = 0.014), WBC (p = 0.046), HGB (p = 0.001), and prothrombin activity (p = 0.023). Logistic regression identified baseline PLT as an independent predictor of treatment response (p = 0.002). PLT began rising by day 5 post-treatment, peaked around day 10, and declined to baseline by day 40 in overall cases and responders. Non-responders showed only mild PLT elevation by day 5 (remaining <50 × 109/L), with no further increase by day 10. No adverse events were observed. No thrombotic or bleeding events were recorded in this small cohort; however, the limited sample size precludes definitive conclusions on thrombosis risk. Conclusions: Avatrombopag demonstrated high efficacy and favorable safety for elevating PLT in patients with CLD, with a higher baseline PLT predicting a better response.