The application of avatrombopag in chronic liver disease patients with severe thrombocytopenia undergoing procedures in China: a prospective real-world cohort study.

BACKGROUND

Several guidelines recommend individualized treatment to correct severe thrombocytopenia before medium- to high-risk invasive procedures in patients with chronic liver disease, lowering the risk of bleeding. In this multi-center, prospective, non-randomized controlled cohort study, the efficacy and safety of avatrombopag, proven safe and effective in two phase III trials, was further evaluated in China.

MATERIALS AND

METHODS

This real-world study enrolled 341 chronic liver disease patients with severe thrombocytopenia scheduled for medium- and high-risk invasive procedures across 20 sites between 10 June 2021 and 25 April 2023. Avatrombopag (40 mg/day or 60 mg/day, treatment group) or alternatives (rhTPO, rhIL-11, Chinese patent medicine or no medication treatment, control group) were administered based on the doctor's and patient's preferences. Homogeneity was compared between the two groups.

RESULTS

In the per-protocol set of 293 cases (66 patients of the treatment group, 79 female patients), the treatment group showed a higher proportion of patients not requiring transfusion or rescue treatment (90.9% vs. 63.9%, P < 0.001), exhibited more patients with a platelet count of ≥50 × 10 9 /L (78.8% vs. 23.4%, P < 0.001) and higher platelet counts [(75.6 ± 42.9) × 10 9 /L vs. (46.4 ± 23.1) × 10 9 /L, P < 0.001] on the procedure day, and demonstrated lower transfusion rates (7.6% vs. 32.9%, P < 0.001), with fewer WHO ≥ 2-grade bleeding events and comparable adverse events.

CONCLUSION

Avatrombopag effectively raises platelet counts, mitigating the need for transfusions and lowering the bleeding events in real-world scenarios of Chinese chronic liver disease patients with severe thrombocytopenia during the peri-procedure period.