https://orcid.org/0000-0003-0295-2120
Key Points
TPO-RA post-splenectomy was not independently linked to higher thrombosis risk.
Platelet count alone does not predict risk of bleeding or thrombosis
Immune thrombocytopenia (ITP) carries an increased risk of thrombosis, which may be further amplified by splenectomy and thrombopoietin receptor agonists (TPO-RAs). While each intervention has been individually studied for its thrombotic risk, data are lacking on the safety of post-splenectomy TPO-RA use. We conducted a retrospective cohort study of adult ITP patients who underwent splenectomy between 2011 and 2024. Patients were stratified based on post-splenectomy TPO-RA use. The primary outcome was incidence of thrombosis. Secondary outcomes included bleeding, mortality, and hematologic response. Time-to-event analyses and multivariate Cox regression were performed. Among 88 patients, 37 (42%) patients received TPO-RA post-splenectomy. Thrombosis occurred in 17 patients in the TPO-RA group versus 14 patients in the non-TPO-RA group (p=0.07). The 10-year cumulative incidence of thrombosis was numerically higher in the TPO-RA group (57% vs. 36%), with clustering of events within the three months of post-splenectomy TPO-RA initiation. Venous events predominated; arterial events were rare. No significant differences were observed in bleeding or mortality rates between groups. Platelet counts alone did not independently affect bleeding or thrombosis. TPO-RA use after splenectomy was not significantly associated with increased thrombosis risk; however, early initiation may coincide with a high-risk period, and the sustained numerical difference in cumulative incidence throughout follow-up highlights potential clinical relevance. These findings support the need for individualized thromboprophylaxis and prospective evaluation of TPO-RA safety in this setting.
