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Thrombopoietin Receptor Agonist (TPO-RA)

Avatrombopag

Brand names: Doptelet

Adult dose

Dose: Thrombocytopenia in chronic liver disease before procedures: 40 mg or 60 mg once daily for 5 days (dose based on platelet count; 40 mg if platelets 40–<50 × 10⁹/L; 60 mg if <40 × 10⁹/L). Start 10–13 days before procedure. Chronic immune thrombocytopenia (ITP): 20 mg once daily, titrated
Route: Oral
Frequency: Once daily (with food)

Clinical pearls

  • Indicated for: (1) thrombocytopenia in chronic liver disease before elective procedures (to reduce transfusion need); (2) chronic immune thrombocytopenia (ITP) after other treatments
  • NICE TA639 (2020): avatrombopag for ITP in adults
  • NICE TA609 (2020): avatrombopag for thrombocytopenia in chronic liver disease
  • Platelet response typically peaks 10–13 days after the 5-day course — time procedure accordingly
  • VTE risk in hepatic disease is significant — risk:benefit assessment mandatory; short course only
  • Does not require food for ITP use; food increases bioavailability for liver disease indication

Contraindications

  • Hypersensitivity to avatrombopag
  • Portal vein thrombosis risk in hepatic disease (use with caution — TPO-RA increases thromboembolic risk)

Side effects

  • Thromboembolic events (DVT, PE, portal vein thrombosis — especially in liver disease)
  • Headache
  • Fatigue
  • Nausea
  • Pyrexia

Interactions

  • Dual CYP2C9 and CYP3A4 inhibitors/inducers — affect avatrombopag levels (see SmPC)
  • CYP3A4 inducers (rifampicin) — reduce avatrombopag levels

Monitoring

  • Platelet count (before, during, and after treatment)
  • Signs of thromboembolism (especially in chronic liver disease)
  • FBC
  • LFTs

Reference: BNF; NICE TA639 (Avatrombopag for ITP, 2020); NICE TA609 (Avatrombopag for chronic liver disease thrombocytopenia, 2020); BSH ITP Guidelines (2019 updated); https://bnf.nice.org.uk/drugs/avatrombopag/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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