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

Abstract

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.

Keywords

Immune thrombocytopenia / Thrombopoietin receptor agonists / Thrombosis / Risk factors

Ethics approval

The study was approved by the Ethics Review Board of the Institution of Blood Diseases Hospital, Chinese Academy of Medical Sciences (reference numbers: NKRDP2023006-EC-2). The human information and medical records used in this study were obtained from previous clinical diagnoses and treatments. Waiving informed consent will not adversely affect their individual rights or health. This study adheres to the ethical principles of the Declaration of Helsinki. Therefore, the ethics committee approved an exemption from the requirement to obtain signed informed consent.

Data availability

No datasets were generated or analysed during the current study.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

This work was supported by grants from the National Key Research and Development Program of China (2023YFC2507802, F.X.); National Natural Science Foundation of China (No. 82470136, R.C.Y., No. 82570173 H.Y.L.); CAMS Innovation Fund for Medical Sciences (CIFMS) (2025-I2M-C&T-B-079 X.F.L.), Tianjin Municipal Science and Technology Commission Grant (25ZXZSSS00510, L.Z.).

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