Thrombopoietin receptor agonists and thrombotic risk in immune thrombocytopenia

The thrombopoietin receptor agonists are undoubtedly the first choice as a second-line treatment in primary immune thrombocytopenia, due to their effectiveness and good safety profile. Although debatable, some authors consider them inappropriate as a therapeutic option in patients at high thrombotic risk, perhaps overlooking the thrombogenic nature of the disease, which may restrict their use and limit therapeutic benefit in some patients. We reviewed the literature and explored thrombotic risk not only associated with thrombopoietin receptor agonists, but also with other therapeutic options and the disease itself.