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Vaskulárna medicína 1/2025
The use of avatrombopag in a patient with chronic liver disease and severe thrombocytopenia prior to major orthopaedic surgery – a case report
Introduction: Chronic liver diseases (CLD) are etiologically different diseases associated with complex changes in haemostasis. Up to almost 90% of patients with the liver cirrhosis have thrombocytopenia, but it also occurs in patients without cirrhotic remodelling. Thrombocytopenia is mainly caused by platelet sequestration in the enlarged spleen and reduced thrombopoietin synthesis in the liver, and thus reduced thrombopoiesis. The severity of thrombocytopenia can be mild to severe. The severe thrombocytopenia complicates the necessary invasive procedures and may be the reason for their postponement.
Case description: The article presents the case of a patient with severe thrombocytopenia in CLD and successful preparation with avatrombopag before major orthopedic surgery.
Conclusion: By using an avatrombopag thrombopoietin receptor agonist, it is possible to achieve adequate and safe platelet count in patients with CLD and planned invasive procedure even without transfusion of platelet concentrate.
Keywords: chronic liver diseases, thrombocytopenia, rebalanced hemostasis, avatrombopag, invasive procedure
