Efficacy of Eltrombopag VS Avatrombopag in Thrombocytopenia in Dengue Patients

Open Access

Abstract

Background: Thrombocytopenia is a common and potentially serious complication of dengue infection, often requiring close monitoring and supportive care. Thrombopoietin receptor agonists, including eltrombopag and avatrombopag, have emerged as potential therapies to accelerate platelet recovery, although comparative clinical evidence in dengue remains limited. Objective: To compare the efficacy of eltrombopag and avatrombopag in improving platelet counts and recovery outcomes among patients with dengue-associated thrombocytopenia. Methods & Materials: This prospective, comparative, observational study was conducted in the Department of Medicine at Monno Medical College & Hospital, Dhaka, from June to December 2025. A total of 100 adults with laboratory-confirmed dengue infection and thrombocytopenia were enrolled and received either eltrombopag (n = 50) or avatrombopag (n = 50) as part of routine clinical care. Serial platelet counts, achievement of platelet thresholds (≥50 × 10³/µL and ≥100 × 10³/µL), and recovery outcomes were compared. Results: Baseline demographic and clinical characteristics were comparable between groups. Platelet counts declined initially on Day 1, then progressively recovered from Day 3 onward. Eltrombopag produced consistently higher platelet counts and achieved significantly greater recovery by Day 6 than avatrombopag (138.2 ± 30.5 vs 121.6 ± 28.7 × 10³/µL; P = 0.04). Early platelet recovery by Day 4 occurred more frequently with eltrombopag (56.0% vs 44.0%), although the difference was not statistically significant. Conclusion: Both eltrombopag and avatrombopag effectively improved platelet counts in dengue-associated thrombocytopenia. Eltrombopag demonstrated a trend toward faster and greater platelet recovery, suggesting a potential therapeutic advantage.