The efficacy and safety of thrombopoietin receptor agonists in patients with chronic liver disease undergoing elective procedures: a systematic review and meta-analysis

• Published in: Platelets (Edinburgh) 2022-01, Vol.33 (1), p.66-72
• Main Authors: Lindquist, Ingrid, Olson, Sven R., Li, Ang, Al-Samkari, Hanny, Jou, Janice H., McCarty, Owen J. T., Shatzel, Joseph J.
• Format: Article
• Language: English
• Subjects: Bleeding; Elective Surgical Procedures - methods; Humans; Liver Diseases - drug therapy; Liver Diseases - surgery; procedures; Randomized Controlled Trials as Topic; Receptors, Thrombopoietin - agonists; thrombopoietin
• ISSN: 0953-7104; 1369-1635
• DOI: 10.1080/09537104.2020.1859102

Thrombopoietin receptor agonists (TPO-RAs) can mitigate preprocedural thrombocytopenia in patients with chronic liver disease (CLD) however their effects on procedural outcomes is unclear. In this meta-analysis, we aimed to better define the efficacy, thrombotic risk and bleeding mitigation associated with the use of preoperative TPO-RAs in patients with CLD. We performed a systematic review and meta-analysis of randomized placebo-controlled clinical trials to assess the use of preprocedural TPO-RAs in patients with CLD, searching MEDLINE, EMBASE and the Cochrane library database. Six publications comprising eight randomized trials (1229 patients; 717 received TPO-RAs, 512 received placebo) and three unique TPO-RAs were retrieved. The majority of the included procedures were endoscopic. TPO-RAs were significantly more likely to result in a preoperative platelet count greater than 50 x 10 9 /L (72.1% vs 15.6%, RR 4.8, 95% CI 3.6-6.4 p