Change in Platelet Count after Transjugular Intrahepatic Portosystemic Shunt Creation: An Advancing Liver Therapeutic Approaches (ALTA) Group Study

 

Clinical question

How does TIPS affect platelet count and recovery?

Take away point

TIPS only increased platelets for patients with a pre-procedure count less than 50,000 per microliter.

Reference

Wong RJ, Ge J, Boike J, German M, Morelli G, Spengler E, Said A, Desai A, Couri T, Paul S, Frenette C, Verna EC, Goel A, Fallon M, Thornburg B, VanWagner L, Lai JC, Kolli KP. Change in Platelet Count after Transjugular Intrahepatic Portosystemic Shunt Creation: An Advancing Liver Therapeutic Approaches (ALTA) Group Study. J Vasc Interv Radiol. 2023 Aug;34(8):1364-1371

Click here for abstract

Study design

Case control study

Funding Source

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 & Associates) had no inpu into the overall design and conduct of the ALTA study.

Setting

Multicenter study

Figure

Histogram of change in platelet count at 4 months after transjugular intrahepatic portosystemic shunt (percentage).

Summary

TIPS creation is an effective intervention for ascites and variceal bleeding in patients with cirrhosis. However, research regarding the impact of TIPS creation on thrombocytopenia is limited, and results have yielded conflicting results. This study was conducted in a multicenter cohort of patients with cirrhosis who underwent TIPS creation and attempted to identify factors associated with platelet count increase after TIPS creation.

Demographic and clinical data were obtained from participating study sites and uploaded to a central study database using Research Electronic Data Capture software hosted at the organizing center. Platelet counts were evaluated at 4 months after TIPS creation to allow sufficient time for post-TIPS recovery and "recalibration".

Percentage change in platelet counts was chosen rather than absolute change because it takes into account the baseline of the patient. The top quartile for platelet count increase was isolated and assessed for patient factors associated with inclusion in this group.

601 patients with cirrhosis underwent TIPS creation at 9 U.S. hospitals from 2010 to 2015, of which 184 (15%) died within 4 months and 115 (9%) underwent transplantation within 4 months. Two hundred twenty-seven (38%) patients were women, with a median age of 57 years.

The median absolute change in platelet count from before to after TIPS was 1,000/microliter. In the subgroup of those with severe thrombocytopenia, there was a significant absolute change in platelet count. In univariable and multivariable logistic regression analyses, older age, lower pre-TIPS platelet count, and higher pre-TIPS MELD were significantly associated with being in the top quartile for platelet increase 4 months after TIPS creation.

Commentary

Previous studies have presented conflicting evidence as to whether TIPS has a positive impact on thrombocytopenia. This large multicenter study of 601 patients who underwent TIPS did not show a significant increase in platelet counts after TIPS. However, when assessing subgroups, patients with platelet counts less than 50,000/microliter prior to TIPS did have improvement in thrombocytopenia. The study suggests that certain subgroups may see a greater improvement in platelet counts following TIPS. The study does have significant limitations, including retrospective nature, lacking information on splenic embolization, and lacking information on medical treatment of thrombocytopenia. These issues could be addressed subsequent prospective studies.

Post author

Timothy Huber, MD
Jefferson Radiology
@IR_Huber