{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:04:58Z","timestamp":1790172298311,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although randomized controlled trials (RCTs) have established evidence regarding thromboembolic risks of thrombopoietin receptor agonists (TPO\u2010RAs) in immune thrombocytopenia (ITP) during short\u2010term follow\u2010up, the long\u2010term risks remain uncertain. This meta\u2010analysis integrates data from prospective studies and RCTs to provide a comprehensive evaluation of thromboembolic risks associated with TPO\u2010RA therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 23, 2025 for RCTs and prospective studies reporting thromboembolic events in patients treated with TPO\u2010RAs. The primary outcome was the risk of any thromboembolism. Subgroup analyses separately assessed the incidence of venous and arterial thrombosis. Short\u2010term (\u2264\u20096\u2009months) evidence was derived from RCTs, while long\u2010term (6\u201312\u2009months and\u2009&gt;\u200912\u2009months) evidence was supplemented by prospective studies. Data from RCTs were analyzed using the Peto odds ratio (OR) with 95% confidence intervals (CIs), and data from prospective studies were pooled to calculate the incidence of thromboembolic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analysis included 12 RCTs (involving 1530 patients) and 11 prospective studies (involving 1820 patients). TPO\u2010RAs significantly increased thromboembolic risk compared to placebo in the short\u2010term (0.72% vs. 0.23%, Peto OR\u2009=\u20093.25, 95% CI\u2009=\u20091.11\u20139.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Pooled results from prospective studies demonstrated thromboembolism incidence of 3.84% at 6 to 12\u2009months and 5.59% beyond 12\u2009months of treatment with TPO\u2010RAs. The reported incidence of arterial thrombosis increased from 0.14% (\u2264\u20096\u2009months) to 1.51% (6\u201312\u2009months), and further to 4.2% (&gt;\u200912\u2009months). Whereas the reported incidence of venous thrombosis increased from 0.18% (\u2264\u20096\u2009months) to 2.50% (6\u201312\u2009months), and plateaued at 2.55% beyond 12\u2009months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This analysis demonstrates that TPO\u2010RAs therapy increases the risk of thromboembolism, with the risk of arterial events becoming particularly pronounced during long\u2010term use. These findings highlight the need for individualized risk assessment and vigilant monitoring in patients receiving TPO\u2010RAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70075","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T01:04:28Z","timestamp":1762995868000},"page":"764-773","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Thromboembolic Risk of Thrombopoietin Receptor Agonists for Adult Primary Immune Thrombocytopenia: A Systematic Review and Meta\u2010Analysis Integrating Randomized Controlled Trials and Prospective Evidence"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3976-9813","authenticated-orcid":false,"given":"Meng\u2010Fei","family":"Dai","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Zhejiang Cancer Hospital Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences  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