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Drug - Doptelet®  (avatrombopag) [Dova]

June 2019

Therapeutic area - Thrombopoiesis Stimulating Proteins

Approval criteria

Patient must:

  • Be 18 years old or older AND
  • Have diagnosis of chronic liver disease AND
  • Have a platelet count of < 50 x 109/L AND
  • Have an invasive procedure scheduled AND
  • Be prescribed a dose according to baseline platelet count (10 tablets per 5 days for platelets ≥ 40 x 109/L or 15 tablets per 5 days for platelets < 40 x 109/L) AND
  • NOT be scheduled for a thoracotomy, laparotomy, open-heart surgery, craniotomy, or organ resection AND
  • NOT be taking Mulpleta AND
  • Have avatrombopag scheduled to begin 10 to 13 days prior to the procedure, with the procedure occurring 5 to 8 days following the last dose of avatrombopag


  • Date of procedure must be submitted at time of request

Quantity limits

  • 5 days (10 or 15 tablets)


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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