Second-line therapy for immune thrombocytopenia

Second-line therapies include splenectomy, rituximab, and TPO-RAs. Use of a second-line therapy is appropriate when glucocorticoids cannot be used and/or are ineffective, provided the diagnosis is confirmed and secondary causes of ITP have been reviewed and treated if present. The patient's values and preferences and their clinical status may change. Patients may benefit from additional time, discussions, and support while making decisions about treatment.