Einsatz von Thrombopoetin-Rezeptor-Agonisten (TPO-RA) vor invasiven Eingriffen bei Patienten mit Leberzirrhose

Zusammenfassung

Fortgeschrittene chronische Lebererkrankungen gehen mit teils ausgeprägten Veränderungen des korpuskulären und plasmatischen Gerinnungssystems einher. Laborchemisch imponiert oft eine Thrombopenie, weswegen in der klinischen Praxis bei Patienten mit Leberzirrhose und Thrombopenie vor invasiven Eingriffen häufig Thrombozytentransfusionen erfolgen, um das Risiko für Blutungskomplikationen zu reduzieren. Diese sind jedoch ihrerseits mit relevanten Risiken und Kosten verbunden, weswegen Maßnahmen zur Einsparung von Thrombozytentransfusion(en) einen hohen klinischen Stellenwert haben. In diesem Zusammenhang ist es vor allem wichtig, sorgfältig zu prüfen, ob eine Anhebung der Thrombozytenzahlen vor invasiven Eingriffen überhaupt erforderlich ist. Neuerdings stehen zudem mit Avatrombopag und Lusutrombopag 2 gut verträgliche Thrombopoetin-Rezeptor-Agonisten (TPO-RA) zur Behandlung der Thrombopenie von Patienten mit Leberzirrhose, die sich einem invasiven Eingriff unterziehen müssen, zur Verfügung. Diese Übersicht soll eine konkrete Entscheidungshilfe geben, ob eine präinterventionelle Anhebung der Thrombozyten erforderlich ist und in welchen Konstellationen der Einsatz von TPO-RA sinnvoll sein kann.

Abstract

Advanced chronic liver disease is accompanied with relevant changes in the corpuscular and plasmatic coagulation system. Due to thrombocytopenia that is regularly observed in these patients, platelet transfusions are often performed prior invasive procedures to prevent possible bleeding complications. However, platelet transfusions are associated with clinically significant adverse events and economically relevant health care costs. Thus, avoiding unnecessary platelet transfusions remains pivotal in daily clinical practice. The first step is to carefully check if increasing platelet counts prior to a planned invasive procedure is really necessary. Nowadays, two well-tolerated thrombopoetin-receptor agonists (TPO-RAs), Avatrombopaq and Lusutrombopaq, to treat thrombocytopenia preemptively before an invasive procedure in patients with liver cirrhosis are available. This review provides a guide for clinician when to increase platelet counts prior an invasive procedure in patients with liver cirrhosis and helps to identify situations in which the use of TPO-RA may be reasonable.

Schlüsselwörter

Leberzirrhose - Thrombopenie - Blutung - Avatrombopag - Lusutrombopag

Keywords

Liver cirrhosis - thromocytopenia - bleeding - avatrombopag - lusutrombopag

Publication History

Received: 10 May 2022

Accepted after revision: 22 August 2022

Article published online:
14 November 2022

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