Proposed molecular mechanism of IMiDs-induced VTEs. THBS-1 is an endogenous substrate of cereblon. IMiDs interfere with the binding of cereblon and THBS-1, leading to the accumulation of intracellular THBS-1. Secreted THBS-1 in plasma inhibits the cleavage activity of ADAMTS13, resulting in the multimerization of vWF. Platelet attachment to large-sized vWF multimer induces platelet activation and promotes thrombus formation during IMiDs treatment. CRBN, cereblon.