Shibata Yuuka, Koga Yuki, Sato Yuki, Mashida Emiko, Kawaoka Tomokazu, Murakami Eisuke, Amioka Kei, Johira Yusuke, Naruto Kensuke, Taogoshi Takanori, Yokooji Tomoharu, Tsuge Masataka, Matsuo Hiroaki
Department of Pharmaceutical Services, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Japan.
Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Japan.
J Pharm Health Care Sci. 2025 Aug 14;11(1):74. doi: 10.1186/s40780-025-00456-z.
The risk of hemorrhagic complications in patients with chronic liver disease during invasive procedures should be considered. Patients with low platelet counts were administered platelet products prior to procedures based on a physician's judgment. However, there are no standards for allocating the bleeding risk associated with each procedure, platelet counts to avoid these risks, or methods for determining platelet counts. In this study, we evaluated whether pharmacists could reduce the use of platelet products by suggesting thrombopoietin receptor agonists using protocol-based pharmacotherapy management to assess procedural bleeding risk and platelet counts.
Among patients with chronic liver disease who were scheduled to undergo invasive procedures between August 2022 and February 2023, those who were interviewed by a pharmacist prior to the procedures were defined as the intervention group (n = 80) and the others as the non-intervention group (n = 224). The protocol was to define the procedural bleeding risk and platelet count. Pharmacists suggested prescribing a thrombopoietin receptor agonist to patients with platelet counts below the recommended counts.
The use of platelet products and thrombopoietin receptor agonists was 0% and 7.5% and 3.1% and 0% in the intervention and non-intervention groups, respectively. Among the patients who were required to receive lusutrombopag, all patients in the intervention groups did not receive platelet product but lusutrombopag alone. However, the rates of patients with the recommended platelet count were not different between the intervention and non-intervention groups.
The use of platelet products decreases without the increased incidences of hemorrhage if pharmacists suggest prescribing thrombopoietin receptor agonists based on their assessment of the platelet count and the bleeding risk of the procedure.
应考虑慢性肝病患者在侵入性操作过程中发生出血并发症的风险。血小板计数低的患者在操作前根据医生的判断给予血小板制品。然而，对于分配与每种操作相关的出血风险、避免这些风险所需的血小板计数或确定血小板计数的方法，尚无标准。在本研究中，我们评估了药剂师是否可以通过使用基于方案的药物治疗管理来评估操作出血风险和血小板计数，从而建议使用血小板生成素受体激动剂来减少血小板制品的使用。
在2022年8月至2023年2月期间计划进行侵入性操作的慢性肝病患者中，在操作前接受药剂师访谈的患者被定义为干预组（n = 80），其他患者为非干预组（n = 224）。该方案旨在确定操作出血风险和血小板计数。药剂师建议为血小板计数低于推荐计数的患者开具血小板生成素受体激动剂。
干预组和非干预组中血小板制品和血小板生成素受体激动剂的使用率分别为0%和7.5%以及3.1%和0%。在需要接受芦曲泊帕的患者中，干预组的所有患者均未接受血小板制品，而是仅接受了芦曲泊帕。然而，干预组和非干预组中达到推荐血小板计数的患者比例没有差异。
如果药剂师根据对血小板计数和操作出血风险的评估建议开具血小板生成素受体激动剂，则血小板制品的使用会减少，且出血发生率不会增加。
