Background: Immune thrombocytopenia (ITP) in adulthood is characterized by chronic
relapsing course. Despite the efficacious first line treatment (corticosteroid, intravenous
immunoglobulin), majority of patients will enter the chronic phase warranting another treatment
approach. Until recently, splenectomy performed in ITP chronic phase represented the standard of
care with longterm remissions in more than 70% of patients, but it has never been tested in clinical
trials. However, with the advances of our understanding of ITP pathophysiology and the shifting
focus on megakaryocyte impairment, novel drugs were introduced in the treatment paradigm, mainly
trombopoietin receptor agonists (TPO-RAs); romiplostim and eltrombopag.
Methods: These TPO-RAs were tested in randomized controlled trials resulting in adequate platelet
response with few side effects and less need for additional therapy leading to approval of
corresponding regulatory agencies and wide acceptance by hematological community, but however
TPO-RAs must be taken continuously to maintain the response. With their onset, the rate of
splenectomy in chronic ITP has diminished in modern era.
Conclusion: The main aim behind conducting this review is to evaluate the pros and cons of
splenectomy compared to TPO-RAs treatment in order to provide the critical overview which may
help the practicing clinician in managing often challenging cases of chronic ITP.