efficacy and safety of thrombopoietin receptor agonist (tpo-ra) in patients with chronic liver disease: a systematic review and meta-analysis

Context: the tpo-receptor agonist (tpo-ra) has been extensively studied for its use in thrombocytopenia. objectives: we aimed to systematically analyze the efficacy and safety of tpo-ra in chronic liver disease patients. methods: the study population consisted of adults with chronic liver disease. the intervention was tpo-ra. the primary outcome was the efficacy of tpo-ra (increase in thrombocyte levels and likelihood of avoiding thrombocyte transfusion pre-operatively), while the secondary outcome was the safety of tpo-ra. the demographics of the study and the usage of tpo-ra medications were used to classify the research. results: this review consisted of 1529 chronic liver disease patients who received tpo-ra and 911 who received a comparator (placebo or thrombocyte transfusion). the tpo-ra significantly increased thrombocyte levels by 34.59 × 10^9/l (p < 0.00001). the use of tpo-ra pre-procedure reduced the likelihood of pre-operative platelet transfusion and up to seven days following the scheduled procedure by 88% (p < 0.00001). tpo-receptor agonist was not associated with all-cause mortality (p = 0.77) or an increase in thrombosis events, with a pooled or of 1.36 (p = 0.43). according to a meta-regression analysis, the population may explain the heterogeneity. subsequent leave-one-out sensitivity analysis of the thrombocyte level change after tpo-ra revealed that no single study was accountable for the heterogeneity of thrombocyte level changes. conclusions: the use of tpo-ra increases the thrombocyte levels of chronic liver disease patients and reduces the odds of needing thrombocyte transfusion pre-operatively. tpo-receptor agonist is also safe to use, with no increase in mortality risk or thrombosis risk.