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<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.&#xa0;After 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 1.05–1.54), 90 days (10.7% vs. 7.9%; RR 1.36, 95% CI 1.16–1.59), 1 year (14.9% vs. 12.2%; RR 1.22, 95% CI 1.07–1.39), and full follow-up (22.5% vs. 19.2%; RR 1.17, 95% CI 1.06–1.29). Portal vein thrombosis was more frequent with romiplostim at 1 year, although absolute event rates were low (RR 2.32, 95% CI 1.36–3.96). 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.</p>

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Comparative thromboembolic risk of romiplostim versus eltrombopag in immune thrombocytopenia: a propensity score-matched cohort study

  • 期刊论文

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  • 发表日期：

    2026年7月3日

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  • Anand Shah,
  • Rajvi Gor,
  • Joshua Kra

摘要

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. After 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 1.05–1.54), 90 days (10.7% vs. 7.9%; RR 1.36, 95% CI 1.16–1.59), 1 year (14.9% vs. 12.2%; RR 1.22, 95% CI 1.07–1.39), and full follow-up (22.5% vs. 19.2%; RR 1.17, 95% CI 1.06–1.29). Portal vein thrombosis was more frequent with romiplostim at 1 year, although absolute event rates were low (RR 2.32, 95% CI 1.36–3.96). 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.