Thrombocytopenia in liver cirrhosis: efficacy of eltrombopag and partial splenic artery embolization in determining optimal treatment indications

Background . Thrombocytopenia is a frequent complication of liver cirrhosis that significantly increases the risk of hemorrhagic complications and limits the possibilities of invasive diagnostic and therapeutic procedures. Currently, two fundamentally different approaches are used to correct this condition: pharmacological therapy with thrombopoietin receptor agonists and invasive methods such as partial splenic artery embolization (PSAE). This study presents a comparative analysis of the efficacy and safety of these methods in patients with liver cirrhosis and severe thrombocytopenia. Objective. A comparison of the efficacy and safety, and optimal indications for eltrombopag versus partial splenic artery embolization in the management of thrombocytopenia in patients with liver cirrhosis and hepatic failure. Material and methods. A single-center prospective study was conducted at Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin involving 59 patients with liver cirrhosis and thrombocytopenia (<50×10 9 /L). Noniclusion criteria included oncological diseases, severe renal failure (GFR <45 mL/min), and active infectious processes. Patients were divided into two groups: Group 1 (n=28) received eltrombopag therapy at a dose of 50 mg/day for 14 days; Group 2 (n=31) underwent PSAE. Efficacy was assessed by platelet count dynamics, compensation duration, and complication rates. The literature search was conducted in the following databases: PubMed/MedLine, ResearchGate, and the Russian Scientific Electronic Library (eLIBRARY.RU), covering publications from 2010 to 2024. Results. Eltrombopag therapy achieved target platelet levels (>50×10 9 /L) in 78.6% of patients, but the effect lasted only 6 weeks on average. In the PSAE group, platelet count normalization was observed in 100% of patients 1 month after the procedure, with subsequent increase to 110±17.37×10 9 /L by week 12. The median compensation duration in this group was 50.35±9.12 weeks. Complications after PSAE were recorded in 41.9%, though mortality remained low (3.2%). Conclusions. The study results demonstrate that PSAE provides a more sustained thrombocytopenia correction compared to the drug therapy and may be considered the method of choice for patients with hypersplenism. Eltrombopag remains preferable for short-term preparation for planned invasive procedures. While PSAE complications require careful patient selection, they do not outweigh the method's long-term benefits.