Pre-procedural use of thrombopoietin-receptor agonists in cirrhosis and severe thrombocytopenia: A systematic review and meta-analysis

Department of Gastroenterology/ Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia. Flinders Centre for Epidemiology and Biostatistics, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia. Department of Gastroenterology/ Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia. Department of Gastroenterology/ Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia. Electronic address: asif.chinnaratha@sa.gov.au.

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2021

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Abstract
BACKGROUND Severe thrombocytopenia in cirrhosis can preclude invasive procedures. Platelet transfusion is recommended if platelet count pre-procedure is potential alternative to platelet transfusion is thrombopoietin-receptor (TPO) agonists. AIM: Evaluate TPO-agonist efficacy and safety in cirrhotic patients with severe thrombocytopenia undergoing invasive procedures. METHODS Randomized control trials (RCT) from electronic reference databases were searched from inception till December 2019. PRISMA guidelines were followed. Primary outcome was platelet transfusion avoidance. Secondary outcomes were weighted mean difference (WMD) in platelet count from baseline to pre-procedure and rates of major adverse events (AE). Pooled Odds Ratio (OR) were estimated using a random-effects model. RESULTS Six RCTs with 1,229 patients were included. All studies had low risk of bias. Compared with placebo, those treated with TPO-agonists had a pooled OR of 0.12(0.08-0.17), P<0.01 for platelet transfusion avoidance, and WMD in platelet count (x10 3 /µL) of 35.6(28.6-42.7), P<0.01. Major AE did not differ between groups [Pooled OR: 0.87(0.47-1.62), P=0.66]. CONCLUSION Compared to placebo, TPO-agonists used in cirrhotic patients with severe thrombocytopenia prior to elective invasive procedures had 88% reduced odds of requiring peri-procedural platelet transfusion and increased platelet count pre-procedure, with no difference in AE rates.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine