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Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options
Author(s) -
GIANNINI E. G.
Publication year - 2006
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.02889.x
Subject(s) - thrombopoietin , medicine , chronic liver disease , thrombopoietin receptor , liver disease , erythropoietin , disease , eltrombopag , romiplostim , immunology , pharmacology , platelet , cirrhosis , immune thrombocytopenia , haematopoiesis , genetics , stem cell , biology
Summary In patients with liver disease, thrombocytopenia is a clinical feature that may represent an obstacle to invasive diagnostic or therapeutic procedures, chemotherapy, and anti‐viral treatment. Stimulation of the bone marrow is the most promising therapeutic intervention for thrombocytopenia in patients with chronic liver disease. The description of thrombopoietin and its (de)regulation in patients with chronic liver disease have disclosed new treatment opportunities. Indeed, pharmacologic treatment options for thrombocytopenia can be divided into treatments targeted at the thrombopoietin receptor (synthetic thrombopoietins and thrombopoietin‐mimetic agents), and use of cytokines with general thrombopoietic potential. Unfortunately, use of synthetic thrombopoietin was hampered by the development of neutralizing antibodies, and thrombopoietin mimetic agents have not yet entered clinical studies. Interleukin‐11 proved to be useful in increasing platelet count in patients with chronic liver disease, although its use is limited by side‐effects. Erythropoietin has shown promising results in improving thrombocytopenia in cirrhotic patients. In patients with chronic liver disease, safe and well‐tolerated treatments aimed at improving thrombocytopenia are still lacking. Larger studies are needed to evaluate and better characterize the thrombopoietic potential of erythropoietin. Human studies with thrombopoietin‐mimetic agents are eagerly awaited in order to assess both effectiveness and safety of these drugs.