Doptelet, as a thrombopoietin receptor agonist, has contraindications mainly related to specific thrombotic risk populations and drug allergic reactions. It is necessary to strictly evaluate the individual risk factors of patients before use.

1. Absolute contraindications

(1) Active thrombotic patients: Do not use Dovtelet as it may increase the risk of thrombosis.

(2) Severe allergy history: It is contraindicated for those who are allergic to atorvastatin or excipients, as rapid allergic reactions may occur.

2. Relative contraindications (requiring risk assessment)

(1) Hereditary thrombophilia: Patients with factors such as VLeiden mutation and prothrombin 20210A mutation should carefully evaluate the benefit risk ratio.

(2) Patients with undirected hepatic blood flow: Chronic liver disease with portal vein thrombosis may increase the risk of mesenteric thrombosis and require individualized decision-making.

3. Special population restrictions

(1) Breastfeeding women: During the treatment period and within 28 days after the last dose, breastfeeding is prohibited to avoid drugs affecting the baby's milk secretion.

(2) Severe liver and kidney dysfunction: Child Pugh C grade or creatinine clearance rate<30mL/min patients lack safety data and are not recommended for use.

Long term medication principles for patients with chronic ITP

(1) Adult and pediatric patients over 6 years old should start with oral administration of 20mg per day, adjust the dosage according to platelet count, and maintain a minimum effective dose of ≥ 50 × 10 ⁹/L.

(2) When children aged 1-6 use powders, the initial dose is 10mg per day, which also needs to be adjusted to the maintenance dose through monitoring.

Dose adjustment mechanism for long-term medication

(1) Evaluate platelet count every 2 weeks. If it is below 50 × 10 ⁹/L, increase the dosage level, and if it is above 200 × 10 ⁹/L, downgrade.

(2) Maximum dose limit: Adults should not exceed 40mg per day, and children should not exceed 20mg. If ineffective for 4 weeks, the medication should be discontinued.

6 Monitoring requirements for long-term treatment

(1) Perform weekly platelet testing before stabilization, monthly testing after stabilization, and continue monitoring for 4 weeks after discontinuation of medication.

(2) When the platelet count exceeds 400 × 10 ⁹/L, the medication should be stopped immediately and monitoring should be strengthened to avoid the risk of thrombosis.