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

World J Gastroenterol. 2022 Aug 14;28(30):4061-4074. doi: 10.3748/wjg.v28.i30.4061.


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.

Keywords: Avatrombopag; Chronic liver disease; Lusutrombopag; Platelet transfusions; Thrombocytopenia; Thrombopoietin agonists.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Hemostatics* / therapeutic use
  • Humans
  • Liver Diseases* / complications
  • Liver Diseases* / therapy
  • Platelet Transfusion / adverse effects
  • Thrombocytopenia* / complications
  • Thrombocytopenia* / therapy
  • Thrombopoietin / therapeutic use


  • Hemostatics
  • Thrombopoietin