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. 2023 Aug;34(8):1364-1371.
doi: 10.1016/j.jvir.2023.04.015. Epub 2023 Apr 24.

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

Randi J Wong  1 , Jin Ge  1 , Justin Boike  2 , Margarita German  3 , Giuseppe Morelli  4 , Erin Spengler  3 , Adnan Said  3 , Archita Desai  5 , Thomas Couri  6 , Sonali Paul  6 , Catherine Frenette  7 , Elizabeth C Verna  8 , Aparna Goel  9 , Michael Fallon  9 , Bartley Thornburg  10 , Lisa VanWagner  2 , Jennifer C Lai  1 , K Pallav Kolli  11
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Change in Platelet Count after Transjugular Intrahepatic Portosystemic Shunt Creation: An Advancing Liver Therapeutic Approaches (ALTA) Group Study

Randi J Wong et al. J Vasc Interv Radiol. 2023 Aug.

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.

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Figures

Figure 1.
Figure 1.
Flow diagram of patients included in the study. TIPS = transjugular intrahepatic portosystemic shunt.
Figure 2.
Figure 2.
Histogram of change in platelet count at 4 months after transjugular intrahepatic portosystemic shunt (percentage).
Figure 3.
Figure 3.
Four months post-TIPS platelet count versus pre-TIPS platelet counts. TIPS = transjugular intrahepatic portosystemic shunt.
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