Comparative Study Of Avatrombopag Versus Partial Splenic Embolization For Treating Thrombocytopenia In Hepatocellular Carcinoma With Splenomegaly

Objectives:The aim was to analyze and compare the efficacy and safety of PSE and Avatrombopag in treating thrombocytopenia in hepatocellular carcinoma(HCC)patients with splenomegaly.Materials and Methods:This study retrospectively analyzed 60 patients with thrombocytopenia in HCC with splenomegaly who received PSE or Avatrombopag treatment from January 2018 to February 2021.There were 49 males and 11 females.The PSE group underwent partial splenic artery embolization,while the Ava group received Avatrombopag therapy for 5 consecutive days:patients with platelet(PLT)count 40–50×10~9/L had an oral intake of 40 mg/d;patients with PLT count<40×10~9/L were given an oral intake of 60 mg/d.During the 1-month follow-up,by comparing the platelet counts at baseline,4±1 days after the intervention,7±1 days after the intervention,12±2 days after the intervention,and 1 month after the intervention,the platelet response rate,platelet count Over time,and the side effects.Results:There was no significant difference in age,gender,baseline value of platelet count,Child-Pugh classification and other baseline data between the Avatrombopag group and the PSE group(P>0.05).The platelet response rate between the Avatrombopag group and the PSE group No significant difference(P>0.05).The PSE and Avatrombopag groups exhibited no significant differences in the effective rate and PLT count(×10~9/L)12±2 days after the intervention(114.7±57.3×10~9/L vs.89.8±43.5×10~9/L,P=0.061,95%CI-1.24-51.147×10~9/L).1 month after the intervention,the platelet count in the PSE group was significantly higher than that in the Avatrombopag group(P<0.001,95%CI,20.741-60.956×10~9/L).The results of multiple linear regression analysis showed that BCLC stage,Child-Pugh grade,age,red blood cells and white blood cells had no significant effect on platelet count.The Avatrombopag group showed good tolerance with a significantly lower incidence of side effects(25.8%vs.93.1%,P<0.001).Conclusion:Avatrombopag markedly improved the PLT count of patients with liver-cancer-related thrombocytopenia,presenting good tolerance.The short-term efficacy of Avatrombopag was similar to that of PSE therapy yet showed superior safety,indicating that Avatrombopag could serve as an alternative to PSE that can be preventively applied before diagnostic or therapeutic manipulation with bleeding risk,and 10-14 days after treatment is the appropriate surgical window period.