Changes in Platelet Counts and Thrombocytopenia Risk in Patients with Chronic Liver Disease with Different Etiologies Using Real-World Japanese Data

Evaluation of the Efficacy of Lusutrombopag for Chronic Liver Disease Based on Pre-Treatment Platelet Counts: A Retrospective Multicenter Study

Background

Oral thrombopoietin receptor agonists are used to treat thrombocytopenia in patients with chronic liver disease who are scheduled for invasive procedures. The efficacy of lusutrombopag based on the pretreatment platelet count was investigated.

Methods

Patients treated at nine hospitals from December 2015 to December 2023 were included. Efficacy was assessed by comparing the proportion of patients achieving a platelet count ≥ 50 000/μL and the change in platelet count.

Results

Seventy patients were eligible for evaluation. Patients with a pretreatment platelet count < 40 000/μL had a significantly lower rate of achieving a platelet count of ≥ 50 000/μL than those with a pretreatment count of 40 000-50 000/μL (62.5% vs. 84.2%, p = 0.038); however, there was no significant difference in the change in platelet count (25 700 vs. 24 400/μL, p = 0.972). Patients with viral-related cirrhosis showed a significantly greater change in platelet count than the others (29 100 vs. 19 200/μL, p = 0.012). For patients receiving multiple lusutrombopag treatments, the change in platelet count was significantly lower in the second treatment than in the first treatment (26 900 vs. 20 800/μL, p = 0.041). The main adverse event observed was thrombosis (2.9%).

Discussion

Lusutrombopag increases platelet count regardless of pretreatment levels, but efficacy, defined as achieving a platelet count of ≥ 50 000/μL, may be insufficient in patients with a pretreatment platelet count < 40 000/μL. Additionally, patients with non-viral liver disease responded less well to treatment compared to those with viral liver disease. Therefore, treatment strategies should be tailored based on pretreatment platelet counts and the etiology of liver disease.

Comparative analysis of platelet count and function in patients with compensated and decompensated liver cirrhosis

BACKGROUND

In cirrhosis, both platelet count and function change. It remains unclear if there are differences in platelet count and function changes among patients with cirrhosis at different stages, and the relationship between the two changes is worthy of further investigation.

AIM

To investigate the difference in platelet count and function in patients with compensated and decompensated cirrhosis.

METHODS

One hundred and fifty patients with cirrhosis admitted to the Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University from January 2023 to December 2023 were included in this study. Their clinical data were collected and thromboelastography was used to detect platelet aggregation in peripheral blood. The difference in platelet count and function between patients with compensated cirrhosis and decompensated cirrhosis was compared, and the correlation between platelet count and function and liver function was assessed.

RESULTS

The platelet count [(137.30 ± 63.40) × 10⁹/L vs (79.69 ± 43.80) × 10⁹/L, P < 0.001)] and maximum amplitude (MA) [(51.67 ± 6.61) mm vs (45.68 ± 9.40) mm, P < 0.001)] values of patients with decompensated cirrhosis were significantly lower than those of patients with compensated cirrhosis. Compared with patients without hypersplenism, patients with hypersplenism had lower MA values [(53.59 ± 5.70) × 10⁹/L vs (45.92 ± 9.02) × 10⁹/L, P < 0.01] and higher mean platelet volume (MPV) [(10.89 ± 0.90) fL vs (11.91 ± 1.15) fL, P < 0.01]. The platelet count and MA values were negatively correlated with Child-Pugh score, MELD score, and MELD-NA score. Further analysis of platelet count and function showed that platelet count was positively correlated with MA value (r = 0.6014, P < 0.001) and negatively correlated with MPV (r = -0.4335, P = 0.011); however, when platelet count was < 50 × 10⁹/L, platelet count was not significantly correlated with MA value and MPV value.

CONCLUSION

The platelet count and aggregation function of patients with decompensated cirrhosis are significantly lower than those of patients with compensated cirrhosis, and are closely related to the severity of cirrhosis. When the platelet count is less than 50 × 10⁹/L, the platelet aggregation function is not consistent with the degree of decrease of platelet count.

The role of platelets in non-alcoholic fatty liver disease: From pathophysiology to therapeutics

Platelets are one of the key mediators in thrombosis as well as in the progression of many diseases. An increase in platelet activation and a decrease in platelet count is associated with a plethora of liver diseases. In non-alcoholic fatty liver disease (NAFLD), platelets are highly activated and participate in the disease progression by enhancing the pro-thrombotic and pro-inflammatory state. Some altered platelet parameters such as mean platelet volume, plateletcrits, and platelet distribution width, aspartate transaminase to platelet ratio index, liver stiffness to platelet ratio and red cell distribution width to platelet ratio were found to be associated with NAFLD disease. Further, platelet contributes to the progression of cardiovascular complications in NAFLD is gaining the researcher's attention. An elevated mean platelet volume is known to enhance the risk of stroke, atherosclerosis, thrombosis, and myocardial infarction in NAFLD. Evidence also suggested that modulation in platelet function using aspirin, ticlopidine, and cilostazol help in controlling the NAFLD progression. Future research should focus on antiplatelet therapy as a treatment strategy that can control platelet activation in NAFLD as well as its cardiovascular risk. In the present review, we have detailed the role of platelets in NAFLD and its cardiovascular complications. We further aimed to highlight the growing need for antiplatelet therapy in NAFLD.

Chinese expert consensus on managing thrombocytopenia in patients with cancer and liver injury

Abstract

Thrombocytopenia and liver injury are serious clinical problems in patients with cancer. The etiology of thrombocytopenia in patients with cancer and liver injury (TCLI) is complicated. Managing cancer therapy-induced thrombocytopenia has gradually become standardized, and managing liver injury-associated thrombocytopenia has become more effective with the approval and marketing of relevant drugs. However, the optimal strategy for managing thrombocytopenia in patients with cancer and liver injury remains unclear, and the superposition of thrombocytopenia and liver injury further increases the difficulty of cancer treatment. Therefore, the Committee of Cancer Support Therapy of the Chinese Anti-Cancer Association has organized experts to analyze and discuss relevant literature to form a Chinese expert consensus on managing thrombocytopenia in patients with cancer and liver injury (2022 Edition) to guide clinical practice.

Effectiveness and Safety of Avatrombopag in Liver Cancer Patients with Severe Thrombocytopenia: Real-World Data and Challenges

Background

Avatrombopag has been approved in patients who have severe thrombocytopenia (<50 × 10⁹/L) and chronic liver disease (CLD) while receiving invasive procedures. The real-world application and effectiveness of avatrombopag in the subgroup patients with liver cancer remain unknown.

Methods

Liver cancer patients (including primary liver cancer and colorectal cancer liver metastasis) who had severe thrombocytopenia and received avatrombopag were retrospectively enrolled. Avatrombopag dose, peak and absolute platelet count increase, combination treatment with other thrombopoietic agents, responder (peak count ≥50 × 10⁹/L with absolute increase ≥20 × 10⁹/L) rate, and anticancer treatment effect were analyzed. Thrombosis and bleeding events were assessed.

Results

In total, 93 patients were enrolled, with 72 and 21 in the CLD and non-CLD groups, respectively. Patients with CLD had hepatitis B or C, larger spleen volume, and a higher cirrhosis degree. Baseline platelet counts were similar between two groups (median, 37.0 × 10⁹/L vs. 39.0 × 10⁹/L; P=0.594), while patients without CLD had higher peak platelet (median, 134.0 × 10⁹/L vs. 74.0 × 10⁹/L; P=0.015) and absolute increase (median, 101.0 × 10⁹/L vs. 41.0 × 10⁹/L; P=0.020) after avatrombopag treatment. The responder rate was higher in patients without CLD (100% vs. 76.4%; P=0.010). Combined avatrombopag with other thrombopoietic agents significantly increased platelet count; repeated use of avatrombopag produced similar effects with that of initial treatment. Concerning anticancer treatment effect, patients who responded to avatrombopag had a higher disease control rate. No thrombosis or hemorrhagic events were observed, even in patients with portal vein tumor thrombosis.

Conclusion

Avatrombopag was safe and effective and ensured successful implementation of anticancer treatment in liver cancer patients with severe thrombocytopenia, accompanied with or without CLD.

Preoperative platelet distribution width-to-platelet ratio combined with serum thyroglobulin may be objective and popularizable indicators in predicting papillary thyroid carcinoma

Objectives

The incidence of papillary thyroid carcinoma (PTC) has increased more rapidly than that of any other cancer type in China. Early indicators with high sensitivity and specificity during diagnosis are required. To date, there has been a paucity of studies investigating the relationship between preoperative platelet distribution width‐to‐platelet count ratio (PPR) and PTC. This study thus aimed to assess the diagnostic value of PPR combined with serum thyroglobulin (Tg) in patients with PTC.

Methods

A total of 1001 participants were included in our study. 876 patients who underwent surgery for nodular goiter were divided into the PTC group or benign thyroid nodule (BTN) group according to pathology reports, and 125 healthy controls (HCs) were included. Preoperative hemogram parameters and serum Tg levels were compared among three groups. Receiver operating characteristic (ROC) curve was used to evaluate the value of PPR combined with serum Tg for diagnosing PTC.

Results

Platelet distribution width (PDW) and PPR levels were higher in the PTC group than in the BTN and HC groups (both p < 0.05) but did not significantly differ between the BTN and HC groups. PDW and PPR levels significantly differed in the presence/absence of lymph node metastasis, the presence/absence of capsule invasion (p = 0.005), and TNM stages (p < 0.001). Multivariable analyses indicated that high serum Tg levels [adjusted odds ratio (OR), 1.007; 95% confidence interval (CI), 1.004–1.009; p < 0.001], high neutrophil‐to‐lymphocyte ratio (NLR,adjusted OR, 1.928; 95% CI, 1.619–2.295; p < 0.001), and high PPR (adjusted OR, 1.378; 95% CI, 1.268–1.497; p < 0.001) were independent risk factors for PTC. In ROC analysis, the areas under the curves (AUCs) of serum Tg, PDW, PPR, and NLR for predicting PTC were 0.603, 0.610, 0.706, and 0.685, respectively. PPR combined with serum Tg (PPR + Tg) had a higher diagnostic value (AUC, 0.738; sensitivity, 60%; specificity, 74.7%) compared with PDW + Tg (AUC, 0.656; sensitivity, 64.4%; specificity, 59.9%) and NLR + Tg (AUC, 0.714; sensitivity, 61.6%; specificity, 71.1%).

Conclusions

Preoperative PPR combined with serum Tg may be objective and popularizable indicators for effective predicting PTC.