Cargando…

Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures

Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic environment. Thrombocytopenia is the most common abnormality observed in these patients and recent advances have led to researchers focus the attention on the multifa...

Descripción completa

Detalles Bibliográficos
Autores principales: Gallo, Paolo, Terracciani, Francesca, Di Pasquale, Giulia, Esposito, Matteo, Picardi, Antonio, Vespasiani-Gentilucci, Umberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403422/
https://www.ncbi.nlm.nih.gov/pubmed/36157107
http://dx.doi.org/10.3748/wjg.v28.i30.4061
_version_ 1784773372795682816
author Gallo, Paolo
Terracciani, Francesca
Di Pasquale, Giulia
Esposito, Matteo
Picardi, Antonio
Vespasiani-Gentilucci, Umberto
author_facet Gallo, Paolo
Terracciani, Francesca
Di Pasquale, Giulia
Esposito, Matteo
Picardi, Antonio
Vespasiani-Gentilucci, Umberto
author_sort Gallo, Paolo
collection PubMed
description Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic environment. Thrombocytopenia is the most common abnormality observed in these patients and recent advances have led to researchers focus the attention on the multifactorial origin of thrombocytopenia and on the key role of thrombopoietin (TPO) in its physiopathology. Severe thrombocytopenia (platelet count < 50000/μL) complicates the management of patients with chronic liver disease by increasing the potential risk of bleeding for invasive procedures, which may be therefore delayed or canceled even if lifesaving. In the very last years, the development of new drugs which exceed the limits of the current standard of care (platelet transfusions, either immediately before or during the procedure) paves the way to a new scenario in the management of this population of patients. Novel agents, such as the TPO-receptor agonists avatrombopag and lusutrombopag, have been developed in order to increase platelet production as an alternative to platelet transfusions. These agents have demonstrated a good profile in terms of efficacy and safety and will hopefully allow reducing limitations and risks associated with platelet transfusion, without any delay in scheduled interventions. Altogether, it is expected that patients with chronic liver disease will be able to face invasive procedures with one more string in their bow.
format Online
Article
Text
id pubmed-9403422
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-94034222022-09-23 Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures Gallo, Paolo Terracciani, Francesca Di Pasquale, Giulia Esposito, Matteo Picardi, Antonio Vespasiani-Gentilucci, Umberto World J Gastroenterol Minireviews Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic environment. Thrombocytopenia is the most common abnormality observed in these patients and recent advances have led to researchers focus the attention on the multifactorial origin of thrombocytopenia and on the key role of thrombopoietin (TPO) in its physiopathology. Severe thrombocytopenia (platelet count < 50000/μL) complicates the management of patients with chronic liver disease by increasing the potential risk of bleeding for invasive procedures, which may be therefore delayed or canceled even if lifesaving. In the very last years, the development of new drugs which exceed the limits of the current standard of care (platelet transfusions, either immediately before or during the procedure) paves the way to a new scenario in the management of this population of patients. Novel agents, such as the TPO-receptor agonists avatrombopag and lusutrombopag, have been developed in order to increase platelet production as an alternative to platelet transfusions. These agents have demonstrated a good profile in terms of efficacy and safety and will hopefully allow reducing limitations and risks associated with platelet transfusion, without any delay in scheduled interventions. Altogether, it is expected that patients with chronic liver disease will be able to face invasive procedures with one more string in their bow. Baishideng Publishing Group Inc 2022-08-14 2022-08-14 /pmc/articles/PMC9403422/ /pubmed/36157107 http://dx.doi.org/10.3748/wjg.v28.i30.4061 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Minireviews
Gallo, Paolo
Terracciani, Francesca
Di Pasquale, Giulia
Esposito, Matteo
Picardi, Antonio
Vespasiani-Gentilucci, Umberto
Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures
title Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures
title_full Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures
title_fullStr Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures
title_full_unstemmed Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures
title_short Thrombocytopenia in chronic liver disease: Physiopathology and new therapeutic strategies before invasive procedures
title_sort thrombocytopenia in chronic liver disease: physiopathology and new therapeutic strategies before invasive procedures
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403422/
https://www.ncbi.nlm.nih.gov/pubmed/36157107
http://dx.doi.org/10.3748/wjg.v28.i30.4061
work_keys_str_mv AT gallopaolo thrombocytopeniainchronicliverdiseasephysiopathologyandnewtherapeuticstrategiesbeforeinvasiveprocedures
AT terraccianifrancesca thrombocytopeniainchronicliverdiseasephysiopathologyandnewtherapeuticstrategiesbeforeinvasiveprocedures
AT dipasqualegiulia thrombocytopeniainchronicliverdiseasephysiopathologyandnewtherapeuticstrategiesbeforeinvasiveprocedures
AT espositomatteo thrombocytopeniainchronicliverdiseasephysiopathologyandnewtherapeuticstrategiesbeforeinvasiveprocedures
AT picardiantonio thrombocytopeniainchronicliverdiseasephysiopathologyandnewtherapeuticstrategiesbeforeinvasiveprocedures
AT vespasianigentilucciumberto thrombocytopeniainchronicliverdiseasephysiopathologyandnewtherapeuticstrategiesbeforeinvasiveprocedures