{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T23:48:53Z","timestamp":1791676133108,"version":"4.3.4"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":82,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Hematol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Immune thrombocytopenia (ITP) is associated with both bleeding and thrombotic complications. Thrombopoietin receptor agonists (TPO-RAs), particularly romiplostim and eltrombopag, are widely used as second-line therapy, yet comparative data on thromboembolic risk between these agents remain limited. We conducted a retrospective cohort study using the TriNetX federated research network, including adults with ITP who initiated romiplostim or eltrombopag between January 2010 and December 2025. ITP was defined using ICD-10 code D69.3. Patients with prior TPO-RA exposure, alternative thrombocytopenia etiologies, or thrombotic events within 1 year before treatment initiation were excluded. One-to-one propensity score matching was performed using demographics, comorbidities, prior therapies, concomitant medications, and laboratory variables.\u00a0After matching, 3,055 patients remained in each group. Romiplostim was associated with a higher cumulative risk of any thromboembolism than eltrombopag at 30 days (7.2% vs. 5.7%; RR 1.27, 95% CI 1.05\u20131.54), 90 days (10.7% vs. 7.9%; RR 1.36, 95% CI 1.16\u20131.59), 1 year (14.9% vs. 12.2%; RR 1.22, 95% CI 1.07\u20131.39), and full follow-up (22.5% vs. 19.2%; RR 1.17, 95% CI 1.06\u20131.29). Portal vein thrombosis was more frequent with romiplostim at 1 year, although absolute event rates were low (RR 2.32, 95% CI 1.36\u20133.96). Mean platelet counts were similar at most time points. These findings suggest that romiplostim may be associated with higher cumulative thromboembolic risk than eltrombopag despite comparable platelet counts. Given the retrospective design and potential confounding, these results should be interpreted as hypothesis-generating.<\/jats:p>","DOI":"10.1007\/s00277-026-07160-4","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:43:58Z","timestamp":1783039438000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative thromboembolic risk of romiplostim versus eltrombopag in immune thrombocytopenia: a propensity score-matched cohort study"],"prefix":"10.1007","volume":"105","author":[{"given":"Anand","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajvi","family":"Gor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Kra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"10","key":"7160_CR1","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1056\/NEJMCP1810479","volume":"381","author":"N Cooper","year":"2019","unstructured":"Cooper N, Ghanima W (2019) Immune thrombocytopenia. N Engl J Med 381(10):945\u2013955. https:\/\/doi.org\/10.1056\/NEJMCP1810479","journal-title":"N Engl J Med"},{"key":"7160_CR2","doi-asserted-by":"publisher","unstructured":"van Dijk WEM et al (2023) Evaluation of the procoagulant state in chronic immune thrombocytopenia before and after eltrombopag treatment\u2014a prospective cohort study.\u00a0J. Thromb. Haemost\u00a021 (4): 1020\u20131031. https:\/\/doi.org\/10.1016\/j.jtha.2022.11.039","DOI":"10.1016\/j.jtha.2022.11.039"},{"key":"7160_CR3","doi-asserted-by":"crossref","unstructured":"Bradbury CA et al (Sep. 2021) Mycophenolate mofetil for first-line treatment of immune thrombocytopenia. N Engl J Med 385(10):885\u2013895. 10.1056\/NEJMOA2100596;PAGEGROUP:STRING:PUBLICATION","DOI":"10.1056\/NEJMoa2100596"},{"issue":"23","key":"7160_CR4","doi-asserted-by":"publisher","first-page":"3829","DOI":"10.1182\/BLOODADVANCES.2019000966","volume":"3","author":"C Neunert","year":"2019","unstructured":"Neunert C et al (2019) American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 3(23):3829. https:\/\/doi.org\/10.1182\/BLOODADVANCES.2019000966","journal-title":"Blood Adv"},{"issue":"12","key":"7160_CR5","doi-asserted-by":"publisher","first-page":"664","DOI":"10.3949\/CCJM.88A.20201","volume":"88","author":"S DeSouza","year":"2021","unstructured":"DeSouza S, Angelini D (2021) Updated guidelines for immune thrombocytopenic purpura: expanded management options. Cleve Clin J Med 88(12):664\u2013668. https:\/\/doi.org\/10.3949\/CCJM.88A.20201","journal-title":"Cleve Clin J Med"},{"issue":"9610","key":"7160_CR6","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/S0140-6736(08)60203-2","volume":"371","author":"DJ Kuter","year":"2008","unstructured":"Kuter DJ et al (2008) Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet 371(9610):395\u2013403. https:\/\/doi.org\/10.1016\/S0140-6736(08)60203-2","journal-title":"Lancet"},{"issue":"9763","key":"7160_CR7","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/S0140-6736(10)60959-2","volume":"377","author":"G Cheng","year":"2011","unstructured":"Cheng G et al (2011) Eltrombopag for management of chronic immune thrombocytopenia (RAISE): A 6-month, randomised, phase 3 study. Lancet 377(9763):393\u2013402. https:\/\/doi.org\/10.1016\/S0140-6736(10)60959-2","journal-title":"Lancet"},{"issue":"23","key":"7160_CR8","doi-asserted-by":"publisher","first-page":"2527","DOI":"10.1182\/BLOOD-2017-04-748707","volume":"130","author":"RSM Wong","year":"2017","unstructured":"Wong RSM et al (2017) Safety and efficacy of long-term treatment of chronic\/persistent ITP with eltrombopag: final results of the EXTEND study. Blood 130(23):2527\u20132536. https:\/\/doi.org\/10.1182\/BLOOD-2017-04-748707","journal-title":"Blood"},{"issue":"3","key":"7160_CR9","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1111\/BJH.12260","volume":"161","author":"DJ Kuter","year":"2013","unstructured":"Kuter DJ et al (2013) Long-term treatment with romiplostim in patients with chronic immune thrombocytopenia: safety and efficacy. Br J Haematol 161(3):411\u2013423. https:\/\/doi.org\/10.1111\/BJH.12260","journal-title":"Br J Haematol"},{"issue":"11","key":"7160_CR10","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1002\/PHAR.70075","volume":"45","author":"MF Dai","year":"2025","unstructured":"Dai MF et al (2025) Thromboembolic risk of thrombopoietin receptor agonists for adult primary immune thrombocytopenia: a systematic review and meta-analysis integrating randomized controlled trials and prospective evidence. Pharmacotherapy 45(11):764\u2013773. https:\/\/doi.org\/10.1002\/PHAR.70075","journal-title":"Pharmacotherapy"},{"key":"7160_CR11","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0198504","author":"J Zhang","year":"2018","unstructured":"Zhang J et al (2018) Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis. PLoS One. https:\/\/doi.org\/10.1371\/JOURNAL.PONE.0198504","journal-title":"PLoS One"},{"key":"7160_CR12","doi-asserted-by":"publisher","unstructured":"Puavilai T et al (2020) Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta-analysis. Br. J. Haematol188(3): 450\u2013459. https:\/\/doi.org\/10.1111\/BJH.16161","DOI":"10.1111\/BJH.16161"},{"issue":"12","key":"7160_CR13","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/S40264-015-0337-1","volume":"38","author":"TTL Nguyen","year":"2015","unstructured":"Nguyen TTL, Palmaro A, Montastruc F, Lapeyre-Mestre M, Moulis G (2015) Signal for thrombosis with eltrombopag and romiplostim: a disproportionality analysis of spontaneous reports within VigiBase\u00ae. Drug Saf 38(12):1179\u20131186. https:\/\/doi.org\/10.1007\/S40264-015-0337-1","journal-title":"Drug Saf"},{"key":"7160_CR14","doi-asserted-by":"publisher","unstructured":"Liu Y, Zhang N, Jiang T, Li Y, Xiong Y, Liu Y (2025) Efficacy and safety and analysis of thrombopoietin receptor agonists for the treatment of immune thrombocytopenia in adults: analysis of a systematic review and network meta-analysis of randomized controlled trials and results of real-world safety data. 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