Two elective invasive procedures after a single avatrombopag treatment in a patient with liver cirrhosis and severe thrombocytopenia

Introduction Severe thrombocytopenia(platelet count<50×10^(9)/L)occurs in 1%–2%of patients with liver cirrhosis and is associated with an increased risk of bleeding[1].In this clinical setting,there is no definite agreement on the platelet cut-off below which bleeding risk increases.However,in vitro evidence indicates that thrombin generation is preserved in patients with cirrhosis and platelet counts of>56×10^(9)/L[2].Observational studies found that severe thrombocytopenia may be predictive of post-procedure bleeding after liver biopsy,dental extractions,percutaneous ablation of liver tumors,and endoscopic polypectomy[3].