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<p>Thrombocytopenia, a common side effect of chronic liver disease (CLD), increases bleeding risk during invasive procedures. Thrombopoietin receptor agonists (TPO-RAs) offer an effective alternative to platelet transfusions. A systematic review and meta-analysis assessed the efficacy and safety of TPO-RAs in thrombocytopenia patients undergoing elective procedures. A systematic search (PubMed, Google Scholar, Cochrane Library, up to August 2024) evaluated perioperative thrombopoietin receptor agonists in patients with thrombocytopenia undergoing elective procedures. Primary and secondary outcomes included platelet count ≥50 x 10^9/L, bleeding/thrombotic events, platelet transfusions, adverse effects, rescue treatment, discontinuation, death, and serious adverse effects, analyzed via random-effects model. This meta-analysis synthesized evidence from nine trials and 1,409 patients (819 TPO-RAs vs 590 placebo; mean age ~59 years). TPO-RAs significantly increased the likelihood of achieving platelet counts ≥50×10⁹/L compared with placebo (RR 3.93, 95% CI 2.24–6.90; p&lt;0.00001). They also reduced the need for preoperative platelet transfusions (RR 0.34, 95% CI 0.27–0.44; p&lt;0.00001) and lowered the risk of surgical bleeding (RR 0.64, 95% CI 0.49–0.85; p=0.002). In contrast, no statistically significant differences were observed for thrombotic events (RR 1.24, 95% CI 0.57–2.67; p=0.59), treatment-emergent adverse events (RR 0.99, 95% CI 0.89–1.09; p=0.83), study drug discontinuation (RR 0.74, 95% CI 0.32–1.70; p=0.47), rescue treatment use (RR 0.82, 95% CI 0.34–2.03; p=0.67), all-cause mortality (RR 1.23, 95% CI 0.35–4.35; p=0.75), or serious adverse events (RR 1.13, 95% CI 0.70–1.84; p=0.62). TPO-RAs raise platelet counts and reduce transfusions in CLD patients undergoing invasive procedures. However, close monitoring for thrombotic risks is necessary, and further research is needed to optimize dosing.</p> Graphical Abstract <p></p>

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Efficacy and safety of perioperative thrombopoietin receptor agonists in patients with immune thrombocytopenia and thrombocytopenia secondary to chronic liver disease undergoing elective procedures: A systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Ishwa Shakir,
  • Javeria Shahid,
  • Rehmat Fayaz,
  • Zainab Muhammad Hanif,
  • Muhammad Safwan,
  • Muhammad Nabeel Saddique,
  • Muhammad Suleman,
  • Dalia Mehmood,
  • Talha Kashif,
  • Muhammad Awais,
  • Sheena Shamoon,
  • Inbsaat Iqbal,
  • Muhammad Ali Abid

摘要

Thrombocytopenia, a common side effect of chronic liver disease (CLD), increases bleeding risk during invasive procedures. Thrombopoietin receptor agonists (TPO-RAs) offer an effective alternative to platelet transfusions. A systematic review and meta-analysis assessed the efficacy and safety of TPO-RAs in thrombocytopenia patients undergoing elective procedures. A systematic search (PubMed, Google Scholar, Cochrane Library, up to August 2024) evaluated perioperative thrombopoietin receptor agonists in patients with thrombocytopenia undergoing elective procedures. Primary and secondary outcomes included platelet count ≥50 x 10^9/L, bleeding/thrombotic events, platelet transfusions, adverse effects, rescue treatment, discontinuation, death, and serious adverse effects, analyzed via random-effects model. This meta-analysis synthesized evidence from nine trials and 1,409 patients (819 TPO-RAs vs 590 placebo; mean age ~59 years). TPO-RAs significantly increased the likelihood of achieving platelet counts ≥50×10⁹/L compared with placebo (RR 3.93, 95% CI 2.24–6.90; p<0.00001). They also reduced the need for preoperative platelet transfusions (RR 0.34, 95% CI 0.27–0.44; p<0.00001) and lowered the risk of surgical bleeding (RR 0.64, 95% CI 0.49–0.85; p=0.002). In contrast, no statistically significant differences were observed for thrombotic events (RR 1.24, 95% CI 0.57–2.67; p=0.59), treatment-emergent adverse events (RR 0.99, 95% CI 0.89–1.09; p=0.83), study drug discontinuation (RR 0.74, 95% CI 0.32–1.70; p=0.47), rescue treatment use (RR 0.82, 95% CI 0.34–2.03; p=0.67), all-cause mortality (RR 1.23, 95% CI 0.35–4.35; p=0.75), or serious adverse events (RR 1.13, 95% CI 0.70–1.84; p=0.62). TPO-RAs raise platelet counts and reduce transfusions in CLD patients undergoing invasive procedures. However, close monitoring for thrombotic risks is necessary, and further research is needed to optimize dosing.

Graphical Abstract