Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1260-1271
Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1260
Recombinant human thrombopoietin treatment in patients with chronic liver disease-related thrombocytopenia undergoing invasive procedures: A retrospective study
Jing-Nuo Ding, Ting-Ting Feng, Wei Sun, Xin-Yi Cai, Yun Zhang, Wei-Feng Zhao
Jing-Nuo Ding, Ting-Ting Feng, Wei Sun, Xin-Yi Cai, Yun Zhang, Wei-Feng Zhao, Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Author contributions: All the authors solely contributed to this paper. Ding JN, Feng TT and Zhao WF designed the research study; Ding JN, Feng TT, Sun W, Cai XY, Zhang Y and Zhao WF performed the research; Ding JN, Cai XY and Zhang Y analyzed the data and wrote the manuscript; Feng TT, Sun W and Zhao WF revised the manuscript; all authors have read and approve the final manuscript.
Supported by the Science and Technology Development Plan of Suzhou, Jiangsu Province, China, No. SYS2020009.
Institutional review board statement: The study was reviewed by the ethics committee of the First Affiliated Hospital of Soochow University, and ethical approval was obtained (2020 Ethics Approval No. 216).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at zhaoweifeng@suda.edu.cn. Participants gave informed consent for data sharing.
Open-Access: 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/
Corresponding author: Wei-Feng Zhao, MD, Chief Physician, Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Gusu District, Suzhou 215000, Jiangsu Province, China. zhaoweifeng@suda.edu.cn
Received: September 19, 2022
Peer-review started: September 19, 2022
First decision: October 21, 2022
Revised: October 30, 2022
Accepted: November 16, 2022
Article in press: November 16, 2022
Published online: November 27, 2022
Abstract
BACKGROUND

Chronic liver disease (CLD) related thrombocytopenia increases the risk of bleeding and poor prognosis. Many liver disease patients require invasive procedures or surgeries, such as liver biopsy or endoscopic variceal ligation, and most of them have lower platelet counts, which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders. Unfortunately, there is no defined treatment modality for CLD-induced thrombocytopenia. Recombinant human thrombopoietin (rhTPO) is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy; however, there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.

AIM

To evaluate the efficacy of rhTPO in the treatment of patients with CLD-associated thrombocytopenia undergoing invasive procedures.

METHODS

All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021. Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia. Adverse events related to treatment, such as bleeding, thrombosis, and disseminated intravascular coagulation, were also investigated.

RESULTS

Among the enrolled patients, 78 (78%) showed a platelet count increase after rhTPO use, while 22 (22%) showed no significant change in platelet count. The mean platelet count after rhTPO treatment in all patients was 101.53 ± 81.81 × 109/L, which was significantly improved compared to that at baseline (42.88 ± 16.72 × 109/L), and this difference was statistically significant (P < 0.001). In addition, patients were further divided into three subgroups according to their baseline platelet counts (< 30 × 109/L, 30-50 × 109/L, > 50 × 109/L). Subgroup analyses showed that the median platelet counts after treatment were significantly higher (P < 0.001, all). Ninety (90%) patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO. No serious adverse events related to rhTPO treatment were observed. Overall, rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.

CONCLUSION

rhTPO can improve platelet count, reduce the risk of bleeding, and decrease the platelet transfusion rate, which may promote the safety of invasive procedures and improve overall survival of patients with CLD.

Keywords: Recombinant human thrombopoietin, Invasive procedures, Chronic liver disease, Liver cirrhosis, Thrombocytopenia, Platelet transfusion

Core Tip: Recombinant human thrombopoietin (rhTPO), commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy, has not been extensively investigated in the treatment of chronic liver disease (CLD)-related thrombocytopenia, where there is an increased risk of bleeding and a poor prognosis, especially in patients undergoing invasive procedures or surgery. Our retrospective study evaluates the efficacy of rhTPO in the treatment of patients with CLD-associated thrombocytopenia undergoing invasive procedures. Overall, rhTPO demonstrated good clinical efficacy by improving platelet count, reducing bleeding risk and decreasing the platelet transfusion rate, which can promote the probability of tolerance to receive invasive management and improve overall survival of patients with CLD.