Another clever acronym for the following:  Eltrombopag Evaluated for Its Ability to Overcome Thrombocyopenia and Enable Procedures (NEJM 2012; 367: 716-24).

Eltrombopag is an oral thrombopoietin-receptor agonist which is approved for use in chronic immune thrombocytopenia.

This double-blind, placebo-controlled trial evaluated whether eltrombopag increased platelet counts and reduced platelet transfusions in patients with chronic liver disease & platelet counts less than 50,000 per cubic millimeter.  145 patients received eltrombopag (75 mg once a day) and 147 received placebo.  Patients received therapy for 14 days. Elective procedures were scheduled no more than 5 days after the final dose of study medication (days 15 to 19).

Key findings:

  • Transfusions of platelets were reduced in the treatment group: 28% of patients compared with 81% in placebo group.
  • No differences in significant bleeding episodes noted.
  • Portal venous thrombosis was increased in treatment group with 6 patients compared with 1 patient in placebo group.

Study limitation: no standard practice with regard to use of platelet transfusions for thrombocytopenia (especially with platelet counts between 50,000-80,000)

Platelet transfusions can be problematic with cirrhosis.  Platelet transfusions have a short duration of efficacy, reactions to transfusions can occur, and multiple transfusions can result in antiplatelet antibodies. Nevertheless, the conclusions from this study: ‘until better identification of risk factors for the development of thrombosis…have been conducted, eltrombopag is not recommended as an alternative to platelet transfusion.’

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