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Even if most current guidelines put splenectomy, rituximab and TPO\u2010RAs on the same treatment level, most clinicians and patients clearly prefer to postpone splenectomy and to multiply the lines of medical treatment before considering surgery. The management of ITP refractory to rituximab and TPO\u2010RAs is challenging. Splenectomy is currently performed much less frequently because of a better knowledge of its complications, particularly severe late infections and deep vein thrombosis, and the inability to reliably predict its effectiveness. Furthermore, there is a reluctance to propose splenectomy when other treatments have been ineffective, based on the not well\u2010documented risk that splenectomy could not be effective in such a case. The objective of this update was to review the most recent published data on the long\u2010term tolerability and side effects of splenectomy and the predictors of response and efficacy, especially for patients exposed to multiple medical lines. This update can help physicians and patients with failure of multiple lines of therapy make an informed decision on the indication for splenectomy with the help of up\u2010to\u2010date data.<\/jats:p>","DOI":"10.1111\/bjh.19077","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T23:20:29Z","timestamp":1695338429000},"page":"86-95","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Is splenectomy a good strategy for refractory immune thrombocytopenia in adults?"],"prefix":"10.1111","volume":"203","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6023-5990","authenticated-orcid":false,"given":"Bertrand","family":"Godeau","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre National de R\u00e9f\u00e9rence des Cytop\u00e9nies Auto\u2010Immunes de l'Adulte H\u00f4pital Henri Mondor, F\u00e9d\u00e9ration Hospitalo\u2010Universitaire TRUE InnovaTive theRapy 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