No significant increase in thrombotic risk following the widespread adoption of TPO-RAs in ITP: A comparative study

In patients with primary immune thrombocytopenia (ITP), the risk of thrombosis associated with thrombopoietin receptor agonists (TPO-RAs) remains debated. This study compared the thrombosis occurrence in ITP patients before and after the launch of TPO-RAs in China, to explore the relationship between TPO-RAs and thrombosis in ITP patients. Data from 2005 to 2017 were obtained from an article published by the Blood Disease Hospital, Chinese Academy of Medical Sciences in 2018. The present study included 1915 hospitalized patients in the same center from January 2018 to February 2025. Among these, thrombosis events occurred in 33 cases (1.72%). The incidence of arterial thrombosis was higher than that of venous thrombosis. Male gender, age over 40 years old, hypertension, diabetes, smoking, and TPO-RAs were associated with thrombosis. Neither platelet count nor stage of ITP showed a significant effect on thrombosis risk. Although the utilization rate of TPO-RAs increased significantly after 2018, no corresponding significant change in thrombosis incidence was observed. These findings suggest that thrombosis in ITP patients results from the interplay of multiple risk factors. While the widespread use of TPO-RAs does not appear to increase the overall risk of thrombosis in ITP patients, caution is still advised when administering these agents to patients with pre-existing thrombosis risk factors.