What is the evidence on the use of thrombopoietic agents in patients with CLD?
There are limited data on using thrombopoietic agents in patients with liver disease. The results of a recent study by McHutchison et al showed that the small molecule thrombopoietin receptor (TPO-R) agonist eltrombopag was effective in increasing platelet counts in patients with hepatitis C. Whether to use the thrombopoietin receptor agonists before or after splencectomy is a matter of much debate. The decision should be based on patient comorbidities, age, and patient preference. Splenectomy, rituximab, and the thrombopoietin receptor agonists are all reasonable second-line treatment options and choices should be individualized. References: McHutchison J, et al. N Engl J Med. 2007;357:2227-2236.
