BACKGROUND: Second-generation thrombopoietin receptor agonists (TPO-RAs) are emerging as the new standard for managing thrombocytopenia (TCP) in patients with chronic liver diseases (CLDs) undergoing scheduled procedures. However, practical guidance for their routine use in CLD patients undergoing specific invasive procedures is lacking. METHODS: These practice guidelines were developed by the Initiative Group for Central European Hepatologic Collaboration (CEHC), composed of nine hepatologist/gastroenterologist experts from Central Europe. Using an adapted Delphi process, the CEHC group selected ten invasive procedures most relevant to the hepatology/gastroenterology setting in the region. Consensus recommendations for each invasive procedure are reported as a final percentage of expert panel responses. RESULTS: A consensus was agreed that TPO-RAs should be considered for raising platelet count in CLD patients undergoing scheduled abdominal surgery, high-bleeding risk dentistry, endoscopic polypectomy, endoscopic variceal ligation, liver biopsy, liver surgery, liver transplantation and percutaneous ablation, but it was also agreed that they are less beneficial or not necessary for endoscopy without intervention and paracentesis. CONCLUSIONS: Using a modified Delphi method, experts reached an agreement for TCP management in CLD patients undergoing ten invasive procedures. These practice guidelines may help with decision making and patient management in areas where clinical evidence is absent or limited.

2nd Department of Internal Medicine Faculty of Medicine and L Pasteur University Hospital P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia

Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases 1097 Budapest Hungary

Clinic of Propedeutics of Internal Diseases Gastroenterology and Hepatology Named after 5 Kh Vasilenko Federal State Autonomous Educational Institution of Higher Education 1 M Sechenov 1st Moscow State Medical University of the Ministry of Health of the Russian Federation 119435 Moscow Russia

Department of Gastroenterology and Hepatology University Hospital Split Split School of Medicine 21000 Split Croatia

Department of Gastroenterology University Hospital 'St Ivan Rilski' 1431 Sofia Bulgaria

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Department of Infectious Diseases and Hepatology Medical University of Białystok Zurawia 14 15 540 Białystok Poland

Department of Internal Diseases Institute of Gastroenterology and Hepatology Lasi University of Medicine and Pharmacy Gr T Popa 700115 Lasi Romania

Division of Internal Medicine University Medical Centre Ljubljana 1000 Ljubljana Slovenia

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