Doptelet (Avatrombopag) is an oral thrombopoietin receptor agonist, primarily used for the treatment of thrombocytopenia in adult patients with chronic liver disease prior to a scheduled surgery. As a targeted medication, its rational use requires strict adherence to medication guidelines and close monitoring of relevant indicators.
Precautions for Doptelet (Avatrombopag) Administration
Key Pre-Administration Assessment Points
A comprehensive clinical assessment must be conducted before initiating Avatrombopag treatment.
First, it is necessary to confirm that the patient's platelet count is below 50×10⁹/L, and the administered dose should be determined based on the baseline value: a daily dose of 60 mg (3 tablets) is recommended for patients with a platelet count < 40×10⁹/L, while a daily dose of 40 mg (2 tablets) is recommended for those with a platelet count ranging from 40 to 50×10⁹/L.
It is essential to evaluate the patient's risk factors for thrombosis, including hereditary thrombophilias (such as factor V Leiden mutation, prothrombin 20210A mutation, antithrombin deficiency, or protein C/S deficiency).
For patients with a history of thrombosis or high-risk factors, a careful balance of the benefits and risks is required.
Standardized Administration Regimen
The standard course of Avatrombopag involves oral administration for 5 consecutive days, and medication must be initiated 10–13 days before the scheduled surgery.
Surgery should be performed within 5–8 days after the last dose; this time window is crucial for ensuring the drug's efficacy.
The medication should be taken with food to improve absorption stability. If a dose is missed, it should be taken as soon as possible.
However, a double dose should not be taken at one time, and it is still necessary to ensure the completion of the full 5-day treatment course.
Medication in Special Populations
Avatrombopag is contraindicated in pregnant women. Animal studies have shown that it may cause fetal harm, and women of childbearing age should use reliable contraceptive measures during treatment.
Lactating women should suspend breastfeeding during treatment and for at least 2 weeks after the last dose.
Currently, there is no data on the efficacy of Avatrombopag in patients under 18 years of age.
Data on the use of Avatrombopag in elderly patients is limited, requiring individualized assessment.
Experience with Avatrombopag use in patients with moderate to severe renal impairment (CLcr < 30 mL/min) is insufficient, so the drug should be used with caution.
Medication Monitoring for Doptelet (Avatrombopag)
Dynamic Monitoring of Platelet Count
Monitoring of platelet count is a core component of Avatrombopag treatment.
The baseline platelet count should be accurately measured before drug administration, as this serves as the basis for dose selection.
After administration, the platelet count typically begins to increase within 3–5 days and reaches a peak at 10–13 days. Therefore, a re-test must be conducted on the day of surgery to ensure that the platelet count has risen to a safe level (> 50×10⁹/L).
Regular monitoring is still required after surgery, as the platelet count will gradually decline back to the baseline level around 35 days.
This drug is only used to increase platelet counts related to surgery and should not be used for long-term "normalization" of platelet counts in patients with chronic liver disease.
Early Warning Monitoring for Thrombotic Events
As a thrombopoietin receptor agonist, Avatrombopag carries a risk of thrombosis.
In clinical studies, cases of portal vein thrombosis have been reported in patients with chronic liver disease using this type of medication.
During treatment, close monitoring of thrombosis-related symptoms is necessary, such as lower limb swelling and pain (deep vein thrombosis), difficulty breathing (pulmonary embolism), and chest pain (myocardial infarction).
For patients with known risk factors for thrombosis, the frequency of monitoring should be increased. If necessary, prophylactic anticoagulation may be considered, but a careful balance of bleeding and thrombosis risks is required.
