Thrombocytopenia in liver cirrhosis: efficacy of eltrombopag and partial splenic artery embolization in determining optimal treatment indications

Background. Thrombocytopenia is a frequent complication of liver cirrhosis that significantly increases the risk of hemorrhagic complications and limits the possibilities of invasive diagnostic and therapeutic procedures. Currently, two fundamentally different approaches are used to correct this condition: pharmacological therapy with thrombopoietin receptor agonists and invasive methods such as partial splenic artery embolization (PSAE). This study presents a comparative analysis of the efficacy and safety of these methods in patients with liver cirrhosis and severe thrombocytopenia.

Objective. A comparison of the efficacy and safety, and optimal indications for eltrombopag versus partial splenic artery embolization in the management of thrombocytopenia in patients with liver cirrhosis and hepatic failure.

Material and methods. A single-center prospective study was conducted at Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin involving 59 patients with liver cirrhosis and thrombocytopenia (<50×10⁹/L). Noniclusion criteria included oncological diseases, severe renal failure (GFR <45 mL/min), and active infectious processes. Patients were divided into two groups: Group 1 (n=28) received eltrombopag therapy at a dose of 50 mg/day for 14 days; Group 2 (n=31) underwent PSAE. Efficacy was assessed by platelet count dynamics, compensation duration, and complication rates. The literature search was conducted in the following databases: PubMed/MedLine, ResearchGate, and the Russian Scientific Electronic Library (eLIBRARY.RU), covering publications from 2010 to 2024.

Results. Eltrombopag therapy achieved target platelet levels (>50×10⁹/L) in 78.6% of patients, but the effect lasted only 6 weeks on average. In the PSAE group, platelet count normalization was observed in 100% of patients 1 month after the procedure, with subsequent increase to 110±17.37×10⁹/L by week 12. The median compensation duration in this group was 50.35±9.12 weeks. Complications after PSAE were recorded in 41.9%, though mortality remained low (3.2%).

Conclusions. The study results demonstrate that PSAE provides a more sustained thrombocytopenia correction compared to the drug therapy and may be considered the method of choice for patients with hypersplenism. Eltrombopag remains preferable for short-term preparation for planned invasive procedures. While PSAE complications require careful patient selection, they do not outweigh the method's long-term benefits.

1. . Cai M, Huang W, Lin C, Li Z, Qian J, Huang M, et al. Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications. Eur Radiol. 2016;26(2):370– 380. PMID: 26002134 https://doi.org/10.1007/s00330-015-3839-4

2. Alsayegh F, Alfadhli A, Algharabally A, Almattooq M, Alshameri S, Altarrah M, et al. Literature review and experts opinion for managing thrombocytopenia in chronic liver disease. J Appl Hematol. 2025;16(1):10–16. https://doi.org/10.4103/joah.joah_111_24

3. Mitchell O, Feldman DM, Diakow M, Sigal SH. The pathophysiology of thrombocytopenia in chronic liver disease. Hepat Med. 2016;8:39–50. PMID: 27186144 https://doi.org/10.2147/HMER.S74612

4. Harker LA, Roskos LK, Marzec UM, Carter RA, Cherry JK, Sundell B, et al. Effects of megakaryocyte growth and development factor on platelet production, platelet life span, and platelet function in healthy human volunteers. Blood. 2000;95(8):2514–2522.

5. Maan R, de Knegt RJ, Veldt BJ. Management of thrombocytopenia in chronic liver disease: focus on pharmacotherapeutic strategies. Drugs. 2015;75(17):1981–1992. PMID: 26501978 https://doi.org/10.1007/s40265-0150480-0

6. Song J. The Ashwell-Morell receptor and regulation of thrombopoietin expression. Clin Exp Thromb Hemost. 2015;2(1):1–3. https://doi.org/10.14345/ceth.15001

7. Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int. 2017;37(6):778–793. PMID: 27860293 https://doi.org/10.1111/liv.13317

8. Man Shrestha S. Splenomegaly and hypersplenism in hepatic vena cava syndrome. Hepatol Forum. 2021;2(2):69– 75. PMID: 35783897 https://doi.org/10.14744/hf.2021.2021.0008

9. Kim AR, Sankaran VG. Thrombopoietin: tickling the HSC's fancy. EMBO Mol Med. 2018;10(1):10–12. PMID: 29191946 https://doi.org/10.15252/emmm.201708450

10. Liu ZR, Zhang YM, Cui ZL, Tong W. Effects of thrombopoietin pre-treatment on peri-liver transplantation thrombocytopenia in a mouse model of cirrhosis with hypersplenism. World J Gastrointest Surg. 2023;15(10):2115–2122. PMID: 37969704 https://doi.org/10.4240/wjgs.v15.i10.2115

11. Qureshi K, Patel S, Meillier A. The use of thrombopoietin receptor agonists for correction of thrombocytopenia prior to elective procedures in chronic liver diseases: review of current evidence. Int J Hepatol. 2016;2016:1802932. PMID: 27800187 https://doi.org/10.1155/2016/1802932

12. Saab S, Bernstein D, Hassanein T, Kugelmas M, Kwo P. Treatment options for thrombocytopenia in patients with chronic liver disease undergoing a scheduled procedure. J Clin Gastroenterol. 2020;54(6):503–511. PMID: 32195771 https://doi.org/10.1097/MCG.0000000000001338

13. N'Kontchou G, Seror O, Bourcier V, Mohand D, Ajavon Y, Castera L, et al. Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients. Eur J Gastroenterol Hepatol. 2005;17(2):179– 84. PMID: 15674095 https://doi.org/10.1097/00042737-200502000-00008

14. Wu Y, Li H, Zhang T, Bai Z, Xu X, Levi Sandri GB, et al. Splanchnic vein thrombosis in liver cirrhosis after splenectomy or splenic artery embolization: a systematic review and meta-analysis. Adv Ther. 2021;38(4):1904–1930. PMID: 33687650 https://doi.org/10.1007/s12325-021-01652-7

15. Bazeboso JA, Tshilolo LM, Mbongo CL, Bilbao JI. Partial splenic embolization in a child with sickle cell disease and hypersplenism. J Vasc Interv Radiol. 2016;27(11):1738–1739. PMID: 27926404 https://doi.org/10.1016/j.jvir.2016.06.026

16. Kanters TA, Raaijmakers CPAM, Lohle PNM, de Vries J, Hakkaart-van Roijen L; SPLENIQ study group. Cost effectiveness of splenic artery embolization versus splenectomy after trauma in the Netherlands. J Vasc Interv Radiol. 2022;33(4):392–398.e4. PMID: 34920120 https://doi.org/10.1016/j.jvir.2021.12.011

17. Shabunin AV, Bedin VV, Drozdov PA, Levina ON, Tsurkan VA, Zhuravel OS. Justification for the necessity of simultaneously performing transjugular intrahepatic portosystemic shunt placement and partial splenic embolizationin patients with portal hypertension in the setting of liver cirrhosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2022;27(2):13–19. (In Russ.). https://doi.org/10.16931/1995-5464.2022-2-13-19

18. Liang QS, Xie JG, Yu C, Feng Z, Ma J, Zhang Y, et al. Splenectomy improves liver fibrosis via tumor necrosis factor superfamily 14 (LIGHT) through the JNK/TGF-β1 signaling pathway. Exp Mol Med. 2021;53(3):393–406. PMID: 33654222 https://doi.org/10.1038/s12276-021-00574-2

19. Lee M. Is partial splenic embolization a good option to prevent cirrhotic complications in the long term? J Korean Med Sci. 2019;34(30):e209. PMID: 31373187 https://doi.org/10.3346/jkms.2019.34.e209

20. Huang Y, Ren D, Gao F, Ding Y, Cheng H, Huang X, et al. An updated meta-analysis of partial splenic embolization versus splenectomy in the treatment of hypersplenism due to cirrhosis. Minim Invasive Ther Allied Technol. 2022;31(5):664–675. PMID: 34106805 https://doi.org/10.1080/13645706.2021.1933535

21. Wan P, Zhang KQ, Zhang Y, Bai AP. Clinical efficacy of partial splenic arterial embolization in treatment of hypersplenism in patients with HBV-related cirrhosis. Zhonghua Gan Zang Bing Za Zhi. 2020;28(3):273–275. PMID: 32306663 https://doi.org/10.3760/cma.j.cn501113-20200229-00077