5PSQ-149 Efficacy and safety of avatrombopag in severe thrombocytopenia secondary to chronic liver disease in a patient with history of thrombosis: a case report

<h3>Background and Importance</h3> Thrombocytopenia is frequent in cirrhosis, the final stage of chronic liver disease (CLD). Severe thrombocytopenia, defined as a platelet count (PC) below 50x10⁹/L, increases risk of bleeding during and after invasive procedures, so guidelines recommend PC equal or greater than that number. Avatrombopag is a new thrombopoietin receptor agonist (TRA) indicated to treat severe thrombocytopenia in patients with CLD who are scheduled to undergo an invasive procedure. In other TRA drugs studies, a higher frequency of portal vein thrombosis (PVT) was reported in case of PC greater than 200x10⁹/L. Moreover, patients with CLD are at greater risk of thrombosis. Thus, history of thromboembolic events (TE) was exclusion criteria in avatrombopag clinical trials and there is not any reported case of patients with this precedent. This case therefore is a valuable contribution to the literature. However, in avatrombopag trials, no connection was found between PC and the TE occurred. On the other hand, real-life data on avatrombopag efficacy and safety is still rare. <h3>Aim and Objectives</h3> To describe the use of avatrombopag in a severe thrombocytopenia of a 52-year-old man with CLD and history of PVT who needed a herniated disc invasive procedure. His thrombocytopenia was refractory to platelet transfusions, desmopressin and immunoglobulins. <h3>Material and Methods</h3> Retrospective case report. Clinical data were obtained from medical records. No signs of peripheral venous thrombosis were observed before beginning treatment and the PC was 37x10⁹/L. Based on the PC, the patient was given 60 mg of avatrombopag daily for 5 days and undergo the procedure within 6 days after the last dose. <h3>Results</h3> A blood test on the procedure day ensured that the PC was adequate and not unexpectedly high (69x10⁹/L). Platelet transfusions and other rescue treatments to prevent excessive bleeding were not needed for up to 7 days after surgery. Adverse effects did not happen during treatment neither TE in the following 6 months. <h3>Conclusion and Relevance</h3> A patient with severe thrombocytopenia secondary to CLD and refractory to other therapies, with history of PVT, used avatrombopag, showing an adequate efficacy and safety profile. Nevertheless, it is necessary to continue studying the incidence of TE, especially in patients with risk factors, and the relation between them and the PC. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest