Application of avatrombopag in patients with chronic liver disease-associated thrombocytopenia undergoing high-risk invasive procedures: a single-center, prospective, non-randomized controlled trial

doi:10.3877/cma.j.issn.2095-3232.2026.01.011

Abstract

Abstract:

Objective

To evaluate clinical efficacy and safety of avatrombopag in adult patients with chronic liver disease-associated thrombocytopenia (CHRT) undergoing elective high-risk invasive procedures.

Methods

In this prospective clinical trial, 68 patients with CHRT undergoing elective invasive procedures in the PLA General Hospital were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 49 patients were male and 19 female, aged 50 years on average. According to different treatment regimens, they were divided into the study group (n=17) and routine group (n=51). Patients in the study group were given with avatrombopag orally at preoperative 10 to 13 d, once a day for 5 consecutive d. The dosage was selected according to platelet (Plt) count: the dosage was 60 mg/d when Plt was <40×10⁹/L, and 40 mg/d when Plt was ranged from 40 to 50×10⁹/L. In the routine group, observation or other Plt-elevating treatment methods were mainly used, including Plt transfusion and use of recombinant human thrombopoietin, recombinant human IL-11, eltrombopag and romiplostim, etc. The changes of Plt count, liver function indexes and the incidence of adverse reactions were observed between two groups.

Results

In the screening and baseline phases, the Plt count in the study group was (34±8)×10⁹/L and (34±7)×10⁹/L, significantly lower than (42±7)×10⁹/L and (41±8)×10⁹/L in the routine group (t=-4.134, -3.206, both P<0.05). At postoperative 10 d, the Plt count in the study group was (80±31)×10⁹/L, significantly higher than (49±18)×10⁹/L in the routine group (t=3.738, P<0.05). No significant differences were found in the levels of ALT, AST and TB at baseline, postoperative 1 and 10 d (all P>0.05). There was no statistical significance difference in the incidence of adverse drug reactions between two groups (P>0.05).

Conclusions

As a Plt-elevating agent, avatrombopag can elevate Plt and reduce the risk of surgery-related bleeding. In addition, it possesses high safety, showing potential clinical benefits in patients with CHRT undergoing elective high-risk invasive procedures.

Key words: Avatrombopag, Thrombocytopenia, Chronic disease, Recombinant human thrombopoietin, Invasive procedures

Bin Shi, Lingzhan Meng, Hu Li, Peng Yu, Li Cao, Zizheng Wang, Yanling Shao, Jin Yan, Zhenyu Zhu. Application of avatrombopag in patients with chronic liver disease-associated thrombocytopenia undergoing high-risk invasive procedures: a single-center, prospective, non-randomized controlled trial[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(01): 66-72.

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URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2026.01.011

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Figures/Tables 4

组别	例数	年龄(岁, $x ¯$ ±s)	性别(男/女)	病因(例)					肝病进展(例)		肝性脑病(例)	创伤性操作(例)
组别	例数	年龄(岁, $x ¯$ ±s)	性别(男/女)	HBV	HCV	AH	DILI	AIH	肝硬化	HCC	肝性脑病(例)	MWA	EVL	TACE	脾切除	腹腔穿刺	肝癌氩核刀	肝金标置入
实验组	17	59±6	11/6	15	1	0	1	0	13	4	0	6	0	5	2	0	2	2
常规组	51	59±10	38/13	41	2	5	1	2	26	25	1	29	5	7	2	3	4	1
统计值		t=0.038	χ²=0.470	-					χ²=3.684		-	-
P值		0.097	0.493	0.519					0.055		0.553	0.157

组别	例数	年龄(岁, $x ¯$ ±s)	性别(男/女)	病因(例)					肝病进展(例)		肝性脑病(例)	创伤性操作(例)
组别	例数	年龄(岁, $x ¯$ ±s)	性别(男/女)	HBV	HCV	AH	DILI	AIH	肝硬化	HCC	肝性脑病(例)	MWA	EVL	TACE	脾切除	腹腔穿刺	肝癌氩核刀	肝金标置入
实验组	17	59±6	11/6	15	1	0	1	0	13	4	0	6	0	5	2	0	2	2
常规组	51	59±10	38/13	41	2	5	1	2	26	25	1	29	5	7	2	3	4	1
统计值		t=0.038	χ²=0.470	-					χ²=3.684		-	-
P值		0.097	0.493	0.519					0.055		0.553	0.157

组别	例数	筛选期	基线期	术前1 d	术后10 d
实验组	17	34±8	34±7	68±32	80±31
常规组	51	42±7	41±8	52±28	49±18
t值		-4.134	-3.206	1.905	3.738
P值		<0.001	0.02	0.061	0.02

组别	例数	ALT（U/L）			AST（U/L）			TB（μmol/L）
组别	例数	基线期	术前1 d	术后10 d	基线期	术前1 d	术后10 d	基线期	术前1 d	术后10 d
实验组	17	20(9)	19(8)	65(194)	28(8)	28(9)	127(316)	20(27)	24(23)	38(41)
常规组	51	21(9)	20(12)	74(73)	33(15)	31(18)	116(152)	24(22)	23(24)	34(20)
Z值		-1.067	-1.223	-0.756	-1.799	-0.580	-1.077	-0.198	-0.287	-0.764
P值		0.286	0.221	0.449	0.072	0.562	0.282	0.843	0.774	0.445

组别	例数	发热	恶心	腹痛	贫血	低钠血症	头晕	血栓形成	外周性水肿
实验组	17	2	1	1	0	2	1	1	1
常规组	51	6	0	2	1	0	1	0	0
χ²值		0.002	-	0.095	-	-	0.636	-	-
P值		0.961	0.087	0.758	0.553	0.425	0.425	0.087	0.087

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