Management of thrombocytopenia due to liver cirrhosis: A review

Table 1 Thrombopoietin-receptor agonists for the treatment of thrombocytopenia

Agent	Target disease	Dose (route)
Recombinant human thrombopoietin
rhTPO	Withdrawn from clinical use	(intravenous)
PEG-rHuMGDF	Withdrawn from clinical use	(subcutaneous)
rhIL-11	Chemotherapy-induced TCP[40,42]	50 μg/kg per day (subcutaneous)
	TCP in patients with cirrhosis[43]	50 μg/kg per day (subcutaneous)
TPO mimetrics (peptide TPO receptor agonists and nonpeptide TPO receptor agonists)
Romiplostim	ITP[47-50]	0.2-10 μg/kg once a week (subcutaneous)
	Myelodysplastic syndrome[51-53]	Once a week (subcutaneous)
	HCV-related TCP[54,97]	2 μg/kg once a week (subcutaneous)
Eltrombopag	ITP[55,56]	50 mg once daily (oral)
	HCV-related TCP	25 mg once daily (oral)
E5501	HCV-related TCP (phase II; NCT00914927)

TPO: Thrombopoietin; PEG-rHuMGDF: Pegylated recombinant human megakaryocyte growth and development factor; rhIL-11: Recombinant human interleukin-11; TCP: Thrombocytopenia; ITP: Immune thrombocytopenic purpura; HCV: Hepatitis C virus.

Table 2 Approaches to treat thrombocytopenia induced by liver cirrhosis based on preoperative splenic volume[62]

Splenic volume	SV < 400 mL	400 mL ≤SV ≤700 mL	700 mL< SV
Procedure	L-splenectomy	L-splenectomy	L-splenectomy
		or	or
		Single PSE	Repeated PSE
Target in PSE		Infarcted splenic area	Non-infarcted splenic area
		(infarcted splenic volume)	(infarcted splenic ratio and non-infarcted splenic volume)

SV: Splenic volume; L-Splenectomy: Laparoscopic splenectomy; PSE: Partial splenic embolization. Modified and adapted from reference[62].

Table 3 Comparison between partial splenic embolization and laparoscopic splenectomy for thrombocytopenia caused by liver cirrhosis

Procedure	PSE	L-splenectomy (HALS)
Invasiveness	+	+++
	(no transfusion)	(rarely with major bleeding)
	(local anesthesia)	(general anesthesia)
Platelet increase	++	+++
Specific complication	Splenic abscess	Portal thrombosis, OPSI
Available in case with HCC	Synchronous TACE	Synchronous RFA or hepatectomy

PSE: Partial splenic embolization; L-Splenectomy: Laparoscopic splenectomy; HALS: Hand-assisted laparoscopic splenectomy; OPSI: Overwhelming post-splenectomy infection; HCC: Hepatocellular carcinoma; TACE: Trans-arterial chemoembolization; RFA: Radio frequency ablation.