Literature Review and Experts’ Opinion for Managing Thrombocytopenia in Chronic Liver Disease

Abstract Thrombocytopenia (TCP) commonly complicates chronic liver disease (CLD), with platelet transfusion traditionally serving as the standard therapeutic approach, despite associated risks such as infection, alloimmunization, and transfusion reactions. Recent advancements have introduced thrombopoietin receptor agonists (TPO-RAs), including avatrombopag and lusutrombopag, as safe and effective alternatives for managing TCP in CLD patients who are scheduled for invasive procedures. This review discusses the pathogenesis underlying TCP in CLD, current therapeutic approaches, and evaluates the efficacy and safety profiles of avatrombopag and lusutrombopag. Furthermore, based on clinical expertise and a thorough assessment of the available evidence, the review provides practical recommendations to assist healthcare professionals in managing TCP in CLD patients, especially those undergoing invasive medical procedures or surgeries. These recommendations emphasize individualized treatment decisions guided by the severity of TCP and procedure-related bleeding risks, highlighting the role of TPO-RAs as optimal and beneficial therapeutic alternatives to platelet transfusions.