Abstract
Purpose: To evaluate recovery of platelet count after transjugular intrahepatic portosystemic shunt (TIPS) creation and patient factors predicting platelet recovery after TIPS creation. Materials and Methods: Adults with cirrhosis who underwent TIPS creation at 9 U.S. hospitals from 2010 to 2015 were included in this retrospective analysis. Change in platelets from before TIPS to 4 months after TIPS creation was characterized. Logistic regression was used to assess factors associated with top quartile percentage platelet increase after TIPS. Subgroup analyses were performed among patients with a pre-TIPS platelet count of ≤50 ×109/L. Results: A total of 601 patients were included. The median absolute change in platelets was 1 × 109/L (−26 × 109/L to 25 × 109/L). Patients with top quartile percent platelet increase experienced ≥32% platelet increase. In multivariable analysis, pre-TIPS platelet counts (odds ratio [OR], 0.97 per 109/L; 95% CI, 0.97–0.98), age (OR, 1.24 per 5 years; 95% CI, 1.10–1.39), and pre-TIPS model for end-stage liver disease (MELD) scores (OR, 1.06 per point; 95% CI, 1.02–1.09) were associated with top quartile (≥32%) platelet increase. Ninety-four (16%) patients had a platelet count of ≤50 × 109/L before TIPS. The median absolute platelet change was 14 × 109/L (2 × 109/L to 34 × 109/L). Fifty-four percent of patients in this subgroup were in the top quartile for platelet increase. In multivariable logistic regression, age (OR, 1.50 per 5 years; 95% CI, 1.11–2.02) was the only factor associated with top quartile platelet increase in this subgroup. Conclusions: TIPS creation did not result in significant platelet increase, except among patients with a platelet count of ≤50 × 109/L before TIPS. Lower pre-TIPS platelet counts, older age, and higher pre-TIPS MELD scores were associated with top quartile (≥32%) platelet increase in the entire cohort, whereas only older age was associated with this outcome in the patient subset with a pre-TIPS platelet count of ≤50 × 109/L.
Original language | English (US) |
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Pages (from-to) | 1364-1371 |
Number of pages | 8 |
Journal | Journal of Vascular and Interventional Radiology |
Volume | 34 |
Issue number | 8 |
DOIs | |
State | Published - Aug 2023 |
Funding
The authors acknowledge the American Society for Transplantation Liver and Intestinal Community of Practice Education Subcommittee for providing a forum for investigators to collaborate on the enclosed study. The authors also thank Ms. Cynthia Padilla and Ms. Dyanna Gregory for their invaluable contributions to the conduct of the Advancing Liver Therapeutics Approaches (ALTA) study. This manuscript has been reviewed by the ALTA Study Group for scientific content and consistency of data interpretation with previous ALTA publications. This study was funded by National Institutes of Health KL2TR001870 (to J.G.) and P30DK026743 (to J.G. and J.C.L.). The ALTA Study Group, however, is funded by an investigator-initiated grant from W.L. Gore and Associates. The Northwestern Research Electronic Data Capture is funded, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health research grant UL1TR001422 to the Northwestern University Clinical and Translational Sciences Institute. The sponsor (W.L. Gore and Associates) had no input into the overall design and conduct of the ALTA study. J.G. receives research grant support from Merck . J.B. receives investigator-initiated grant support and consulting fees from W.L. Gore & Associates. E.S. holds stocks or stock options in Abbott. S.P. receives grant support from Genfit and Target PharmaSolutions. L.V. receives receives investigator-initiated and educational grant support from W.L. Gore & Associates (Newark, DE), the manufacturer of the transjugular intrahepatic portosystemic shunt Viatorr stent; reports grants from Intercept Pharmaceuticals, Enanta Pharmaceuticals, and NGM Pharmaceuticals; receives consulting fees from Noble Insights and Gerson Lehrman Group; receives payment for expert testimony from Wapner Newman and Mercaldo Law Firm; and holds leadership roles in the American Association for the Study of Liver Diseases, American Society for Transplantation, and Liver Transplantation (editorial). J.C.L. receives investigator-initiated research grant support from Gore Medical. K.P.K. receives consulting fees from and reports participation on the Data Safety Monitoring Board or Advisory Board of Becton, Dickinson, & Company. None of the other authors have identified a conflict of interest.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine