Thrombopoietin receptor agonists and risk of portal vein thrombosis in patients with liver disease and thrombocytopenia: A meta-analysis

Background: Treatment of thrombocytopenia with thrombopoietin receptor agonists (TPORAs) seems to be associated with portal vein thrombosis (PVT) in patients with chronic liver disease (CLD). We performed a meta-analysis of the trials carried out in this clinical setting to assess if such association is detectable. Methods: We performed a meta-analysis with studies that compared the effect of TPORAS vs placebo in patients with CLD and thrombocytopenia. Results: Four studies, including 1953 patients, reported the incidence of PVT in patients with CLD and thrombocytopenia treated with TPORAs or placebo. No significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.8; 95% C.I., 0.97–8.16; p = 0.055). A significant association between PVT and TPORAs was observed only in patients treated with eltrombopag (O.R.: 3.8; 95% C.I., 1.14–13.2; p = 0.03). Three studies, including 514 patients who were undergoing an elective invasive procedure, analyzed the incidence of PVT in TPORAs—treated patients with CLD and thrombocytopenia; no significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.6; 95% C.I., 0.6–11.6; p = 0.212). A significant difference was found for incidence of arterial and venous thrombo-embolic events in CLD patients treated with eltrombopag compared with placebo-treated patients (O.R.: 3.4; 95% C.I., 1.5–7.7; p = 0.003). Conclusion: The results of this meta-analysis show that TPORAs are not associated with PVT in CLD patients even in the case of surgical procedure. PVT risk seems to be associated only with eltrombopag use.