Chronic liver disease (CLD) alters normal hemostatic and thrombotic systems via multiple mechanisms including reduced platelet function and number, leading to challenging peri-operative planning.Hepatic thrombopoietin (TPO) synthesis is reduced in CLD, leading to several recent randomized, placebo-controlled trials examining the utility of TPO-mimetics Foam Cleanser to increase platelet counts prior to surgery.While these trials do suggest that TPO-mimetics are efficacious at increasing platelet counts in patients with CLD and have led to several SEA RICH OMEGA-3 LEMON recent drug approvals in this space by the U.S.Food & Drug Administration, it remains unclear whether these results translate to the relevant clinical endpoint of reduced perioperative bleeding rate and severity.
In this article, we review several recently-published, phase 3 trials on the TPO-mimetics eltrombopag, avatrombopag and lusutrombopag, and discuss the clinical significance of their results.