***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Eltrombopag is an oral thrombopoietin-receptor agonist . This study evaluated the efficacy of eltrombopag for increasing platelet counts and reducing the need for platelet transfusions in patients with thrombocytopenia and chronic liver disease who are undergoing an elective invasive procedure . METHODS We r and omly assigned 292 patients with chronic liver disease of diverse causes and platelet counts of less than 50,000 per cubic millimeter to receive  eltrombopag  , at a dose of 75 mg daily , or placebo for 14 days before a planned elective invasive procedure that was performed within 5 days after the last dose . The primary end point was the avoidance of a platelet transfusion before , during , and up to 7 days after the procedure . A key secondary end point was the occurrence of bleeding ( World Health Organization [ WHO ] grade 2 or higher ) during this period . RESULTS A platelet transfusion was avoided in 104 of 145 patients who received eltrombopag ( 72 % ) and in 28 of 147 who received placebo ( 19 % ) ( P<0.001 ) . No significant difference between the eltrombopag and placebo groups was observed in bleeding episodes of WHO grade 2 or higher , which were reported in 17 % and 23 % of patients , respectively . Thrombotic events of the portal venous system were observed in 6 patients who received eltrombopag , as compared with 1 who received placebo , result ing in the early termination of the study . The incidence and severity of other adverse events were similar in the eltrombopag and placebo groups . CONCLUSIONS Eltrombopag reduced the need for platelet transfusions in patients with chronic liver disease who were undergoing elective invasive procedures , but it was associated with an increased incidence of portal-vein thrombosis , as compared with placebo . ( Funded by GlaxoSmithKline ; ELEVATE Clinical Trials.gov number , NCT00678587 . ) In anecdotal reports , some patients with immune thrombocytopenia ( ITP ) maintained platelet counts after discontinuing romiplostim . Here , we examined rates of platelet response ( ≥50 × 109/l ) , remission , splenectomy and adverse events in patients with primary ITP duration ≤6 months who were treated with romiplostim for ≤12 months . The starting dose of romiplostim was 1 μg/kg ; concomitant and rescue treatments were permitted to maintain platelet counts . Patients with platelet counts ≥50 × 109/l at the end of 12 months entered a dose taper in which the romiplostim dose was decreased as long as platelet counts were maintained . Remission ( platelet count ≥50 × 109/l for 24 consecutive weeks with no ITP treatments ) was evaluated in patients once romiplostim was discontinued . Over the 12 months , a high response rate ( > 90 % ) was observed . Platelet response occurred quickly ( median , ~2 weeks ) and was observed for a cumulative median of 11 months . Remission was observed in 24 patients ( 32 % ) ; there were no significantly predictors of remission . Most ( 20/24 ) patients had remission start before the forced taper . No new safety signals were identified . Thus , in patients with early‐stage ITP  , romiplostim was well tolerated and induced rapid responses , with remission occurring in approximately one‐third of patients ( NCT01143038 , Amgen 20080435 ) Idiopathic thrombocytopenic purpura ( ITP ) is an autoimmune disorder characterized by persistent thrombocytopenia ( peripheral blood platelet count < 150 · 10 ⁄ l ) due to autoantibody binding to platelet antigen(s ) causing their premature destruction by the reticuloendothelial system , and in particular the spleen ( Woods et al , 1984a , b ) . Although the basic underlying pathophysiology of ITP has been known for 50 years ( Harrington et al , 1951 ) , the literature shows that the investigation and management of patients with thrombocytopenia vary widely , and is not evidence -based , due to a lack of clinical trials and quality research . Despite major advances in our underst and ing of the molecular basis of many blood disorders , the diagnosis of ITP remains one of exclusion ; there are currently no robust clinical or laboratory parameters that are able to establish the diagnosis of ITP with accuracy . This guideline aims to assess available diagnostic tests and therapies , and attempts to provide a rational approach to the diagnosis and treatment in adults , children and in pregnancy . Although natural history data are becoming available ( Cohen et al , 2000 ; Djulbegovic & Cohen , 2001 ; Portielje et al , 2001 ) , there are few r and omized trials in ITP and many of the recommendations , like those of the American Society of Hematology ( ASH ) Panel ( George et al , 1996 ) , are based on expert opinion BACKGROUND Chronic immune thrombocytopenic purpura ( ITP ) is characterised by accelerated platelet destruction and decreased platelet production . Short-term administration of the thrombopoiesis-stimulating protein , romiplostim , has been shown to increase platelet counts in most patients with chronic ITP . We assessed the long-term administration of romiplostim in splenectomised and non-splenectomised patients with ITP . METHODS In two parallel trials , 63 splenectomised and 62 non-splenectomised patients with ITP and a mean of three platelet counts 30x10(9)/L or less were r and omly assigned 2:1 to subcutaneous injections of romiplostim ( n=42 in splenectomised study and n=41 in non-splenectomised study ) or placebo ( n=21 in both studies ) every week for 24 weeks . Doses of study drug were adjusted to maintain platelet counts of 50x10(9)/L to 200x10(9)/L. The primary objectives were to assess the efficacy of romiplostim  as measured by a durable platelet response ( platelet count > or = 50x10(9)/L during 6 or more of the last 8 weeks of treatment ) and treatment safety . Analysis was per protocol . These studies are registered with Clinical Trials.gov , numbers NCT00102323 and NCT00102336 . FINDINGS A durable platelet response was achieved by 16 of 42 splenectomised patients given romplostim versus none of 21 given placebo ( difference in proportion of patients responding 38 % [ 95 % CI 23.4 - 52.8 ] , p=0.0013 ) , and by 25 of 41 non-splenectomised patients given romplostim versus one of 21 given placebo ( 56 % [ 38.7 - 73.7 ] , p<0.0001 ) . The overall platelet response rate ( either durable or transient platelet response ) was noted in 88 % ( 36/41 ) of non-splenectomised and 79 % ( 33/42 ) of splenectomised patients given romiplostim compared with 14 % ( three of 21 ) of non-splenectomised and no splenectomised patients given placebo ( p<0.0001 ) . Patients given romiplostim achieved platelet counts of 50x10(9)/L or more on a mean of 13.8 ( SE 0.9 ) weeks ( mean 12.3 [ 1.2 ] weeks in splenectomised group vs 15.2 [ 1.2 ] weeks in non-splenectomised group ) compared with 0.8 ( 0.4 ) weeks for those given placebo ( 0.2 [ 0.1 ] weeks vs 1.3 [ 0.8 ] weeks ) . 87 % ( 20/23 ) of patients given romiplostim ( 12/12 splenectomised and eight of 11 non-splenectomised patients ) reduced or discontinued concurrent therapy compared with 38 % ( six of 16 ) of those given placebo ( one of six splenectomised and five of ten non-splenectomised patients ) . Adverse events were much the same in patients given romiplostim and placebo .  No antibodies against romiplostim or thrombopoietin were detected . INTERPRETATION Romiplostim was well tolerated , and increased and maintained platelet counts  in splenectomised and non-splenectomised patients with ITP . Many patients were able to reduce or discontinue other ITP medications . Stimulation of platelet production by romiplostim may provide a new therapeutic option for patients with ITP BACKGROUND & AIMS This is a phase II multicentre study to investigate the efficacy and safety of avatrombopag ( E5501 ) , an investigational second-generation thrombopoietin receptor agonist , administered one week prior to elective procedures in patients with thrombocytopenia secondary to cirrhosis . METHODS Adults with cirrhosis and platelet counts ⩾10 to ⩽58 × 10(9)/L were r and omized to placebo or avatrombopag in two sequential cohorts . Cohort A : placebo vs. one of 3 different doses ( 100 mg loading dose followed by 20 , 40 , or 80 mg/day on days 2 - 7 ) of a first-generation avatrombopag formulation . Cohort B : placebo vs. one of 2 different doses ( 80 mg loading dose followed by 10 mg/day for days 2 - 7 , or 20mg/day for days 2 - 4 ) of a second-generation avatrombopag formulation . Primary end point was achievement of a platelet increase of ⩾20 × 10(9)/L from baseline and > 50 × 10(9)/L at least once during days 4 - 8 . RESULTS A total of 130 patients were r and omized : 93 patients ( 51 , cohort A ; 42 , cohort B ) to avatrombopag and 37 ( 16 , cohort A ; 21 cohort B ) to placebo . The primary end point was achieved by 49.0 % of treated patients in cohort A and 47.6 % in cohort B compared to 6.3 % and 9.5 % of controls ; a dose response was seen . Each avatrombopag regimen had a higher proportion of responders compared with their respective cohort placebo arms ( p<0.01 ) , except for the 100/40 mg group in cohort A ( p=0.17 ) . The most common adverse events were nausea , fatigue , and headache . One patient in the ( 100/80 ) avatrombopag group , without a Doppler assessment at screening was diagnosed with portal vein thrombosis during post-treatment follow-up . CONCLUSIONS In this study avatrombopag was generally well-tolerated and increased platelet counts in patients with cirrhosis undergoing elective invasive procedures Avatrombopag , an oral thrombopoietin receptor agonist , was compared with placebo in a 6‐month , multicentre , r and omised , double‐blind , parallel‐group Phase 3 study , with an open‐label extension phase , to assess the efficacy and safety of avatrombopag ( 20 mg/day ) in adults with chronic immune thrombocytopenia ( ITP ) and a platelet count < 30 × 109/l ( Clinical Trials.gov identifier NCT01438840 ) . The primary endpoint was the cumulative number of weeks of platelet response ( platelet count ≥50 × 109/l ) without rescue therapy for bleeding ; secondary endpoints included platelet response rate at day 8 and reductions in the use of concomitant medications . Amongst the 49 patients r and omised , avatrombopag ( N = 32 ) was superior to placebo ( N = 17 ) in the median cumulative number of weeks of platelet response ( 12·4 vs. 0·0 weeks , respectively ; P < 0·0001 ) . At day 8 , a greater platelet response rate was also observed for patients treated with avatrombopag compared with placebo ( 65·63 % vs. 0·0 % ; P < 0·0001 ) , and use of concomitant ITP medications was also reduced amongst patients receiving avatrombopag . The safety  profile of avatrombopag was consistent with Phase 2 studies ; the most common adverse events were headache and contusion . Overall , avatrombopag was well tolerated and efficacious for the treatment of chronic ITP BACKGROUND & AIMS Patients with thrombocytopenia and chronic liver disease ( CLD ) may require platelet transfusions before scheduled procedures to decrease risk of bleeding . We performed 2 r and omized , placebo-controlled , phase 3 trials in patients with thrombocytopenia and CLD undergoing scheduled procedures to evaluate the safety and efficacy of avatrombopag in increasing platelet counts in this patient population . METHODS In the ADAPT-1 and ADAPT-2 studies , adults with thrombocytopenia and CLD ( n = 231 and n = 204 , respectively ) were in 1 of 2 cohorts according to their baseline platelet count ( below 40 × 109 
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Conclusions : This meta- analysis showed that avatrombopag was an effective treatment for thrombocytopenia , but there is sufficient evidence to indicate that adverse events may occur