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https://www.selleckchem.com/products/jnj-64264681.html Severe thrombocytopenia (platelet count less then 50 x 109 / l) is the most frequent hematological disorder in patients with chronic liver disease, affecting 64%-84% of individuals with cirrhosis. The pathophysiological mechanisms that underlie thrombocytopenia are complex, but the reduction of thrombopoietin levels is considered to play a key role. Until recently, there was continuous debate about the optimal management of patients with chronic liver disease and low platelet counts needing a scheduled invasive procedure. Transfusion of platelet concentrates, considered to be the standard of treatment, has major limitations, such as its short lifespan and limited efficacy, but also relevant adverse effects. Avatrombopag is an oral thrombopoietin receptor agonist that induces megakaryocytic proliferation and differentiation, and platelet production. It has been approved by the Spanish Agency of Medicines and Health Products for the treatment of severe thrombocytopenia in adult patients with chronic liver disease before scheduled procedures to decrease the risk of bleeding. Randomized trials have demonstrated this agent to be effective in maintaining platelet counts above 50 × 109 / l over a period of more than 2 weeks, with a similar safety profile to placebo. In this article we review avatrombopag in the treatment of thrombocytopenia of patients with chronic liver disease, discussing the main differences of this intervention in comparison to the previous standard of care therapy.Vitamin B12 has been widely related to methionine metabolism, which is an essential component for biological methylation reactions, including DNA methylation. However, the relationship between vitamin B12 and DNA methylation is still controversial. In addition, there is increasing evidence for the association between vitamin B12 and the risk of colorectal cancer (CRC), although results of this association need to be assessed with caution

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