Use of eltrombopag in thrombocytopenia of liver disease

Table 1 Mechanisms of thrombocytopenia in liver disease

In chronic liver disease

Decreased Thrombopoietin production

Splenic sequestration

Autoantibodies against platelets

Expansion of plasma volume

Bone marrow suppression (Alcohol)

In specific liver diseases

Viral or alcohol related marrow suppression

Autoimmune thrombocytopenia

Cryoglobulins

Drugs: Interferon mediated marrow suppression

Table 2 Studies of Eltrombopag in patients with liver disease

Ref.	Population	Type	Results
McHutchison et al[55]	Compensated HCV cirrhosis with thrombocytopenia	Phase II RCT, placebo controlled	Dose dependent increase noted with eltrombopag
Kawaguchi et al[32]	Cirrhosis	Phase II Randomised Open label study	Risk of thrombotic phenomenon, recommends lower dose in Japanese
Afdhal et al[56] ELEVATE trial	Cirrhosis patients, periprocedural use	Phase III, RCT, placebo controlled	Decreased platelet transfusion with eltrombopag with increased risk of portal vein thrombosis
Afdhal et al[51] ENABLE 1 and 2 trial	HCV related thrombocytopenia, to enable SVR	Phase III, RCT, placebo controlled	Decreased dose reduction in eltrombopag group, Higher SVR

HCV: Hepatitis C virus; SVR: Standard variable rate.