Periprocedural use of avatrombopag for neurosurgical interventions: A strategy to avoid platelet utilization

Abstract

Avatrombopag and lusutrombopag, both second-generation thrombopoietin receptor agonists (TPO-RAs), are approved for periprocedural use in patients with thrombocytopenia secondary to chronic liver disease (CLD). The clinical trials leading to their approval included low-risk procedures defined as paracentesis, thoracentesis, and gastrointestinal endoscopy; moderate-risk procedures defined as liver biopsy, bronchoscopy, ethanol-ablation therapy, and chemoembolization; and high-risk procedures defined as vascular catheterization, transjugular intrahepatic portosystemic shunt, dental procedures, renal biopsy, biliary interventions, nephrostomy tube placement, radiofrequency ablation, and laparoscopic interventions. Patients requiring neurosurgical (eg, intracranial or intraspinal) procedures were excluded.1-3 As such, periprocedural platelet transfusion remains a commonly used strategy for this patient population due to the need for a higher platelet threshold of.100 3 109/L perioperatively.4-7 However, platelets remain a precious commodity, especially during times of increased demand, which may result in threatened blood supply chains.8 Herein, we describe the successful use of avatrombopag to avoid preoperative platelet transfusion for a patient undergoing a neurosurgical procedure that required a minimum platelet threshold of 100 3 109/L.