Lupus & antiphospholipid syndrome
The thrombotic burden of high-risk immune thrombocytopenia patients receiving second-line treatments: a systematic review
Authors' conclusion
We have found a consistent thrombotic burden in high-risk ITP patients on second-line therapy, evident across all examined treatment options, underscoring the pro-thrombotic immune milieu of this population
Study context
- Population
- High-risk immune thrombocytopenia (ITP) (primary ITP with aPL positivity, or secondary ITP associated with an autoimmune disease posing increased thrombotic risk) on second-line treatments
- Participants
- 308 participants13 studies
- Comparison
- Thrombopoietin Receptor Agonists (TPO-RAs) vs Rituximab vs Immune suppressants vs Splenectomy
- Outcome
- Frequency of any thrombotic event during follow-up
Methodological detailsMedline and Embase searched from 2010 to 16 November 2025
- Medline and Embase searched from 2010 to 16 November 2025
Pooled result
As reported in the abstract
Any thrombosis · median follow-up 6 to 42 months
Thrombosis, all high-risk ITP patients on second-line treatment: 40 patients
10%
95% CI 5–19
Further pooled results
| Outcome | TPO-RAs | Rituximab | Immune suppressants | Splenectomy |
|---|---|---|---|---|
| Thrombosis by treatment | 16% (95% CI 11–22) | 14% (95% CI 3–35) | 11% (95% CI 2–28) | 12% (95% CI 4–24) |
Original publication
The thrombotic burden of high-risk immune thrombocytopenia patients receiving second-line treatments: a systematic review. Rheumatology (Oxford). Published 26 August 2026. doi:10.
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