The Critical Vector · Evidence Locker

Thrombopoietin for Thrombocytopenia in Critical Illness

R. E. Suscitate & A. Systole

A narrative review found eleven studies of thrombopoietin-directed therapy in critically ill patients, mostly in sepsis and mostly with a drug Americans can't get. The signal is faster platelet recovery; the evidence is preliminary.

VERIFIEDMorzinski et al., Med J (Ft Sam Houston) 2025Narrative review · 11 studies

3Retrospective cohorts

3Prospective cohorts

2Case reports or series

2Randomized trials

1Systematic review with meta-analysis

Eleven studies from 2014 to 2025, of which two were randomized.

The signal

The authors conclude that limited data suggest thrombopoietin may benefit critically ill patients with thrombocytopenia, and that more studies are needed. In their summary of the sepsis literature:

Faster platelet recovery, often beginning by day 3 and peaking around day 7.
Fewer platelet transfusions and better coagulation profiles in some studies.
A meta-analysis of 10 randomized trials (681 patients) found higher platelet counts by day 7 and a possible reduction in transfusion.
A possible survival benefit in one randomized trial and one retrospective cohort.

The figures above come from the authors' summary of the full text, not the abstract.

US availability

Agent	US status
Recombinant human thrombopoietin (rhTPO)	Not available in the US. Most of the sepsis evidence uses it; it is marketed mainly in China.
Romiplostim	FDA-approved (for immune thrombocytopenia and other indications), not for sepsis or trauma
Eltrombopag, avatrombopag, lusutrombopag	Oral receptor agonists, FDA-approved for other indications; none studied as critical-care rescue

Whether romiplostim would reproduce the rhTPO results is unknown.

Limits

Slow. Platelet effects take days, so these agents cannot replace hemorrhage control or platelet transfusion.
Thrombotic risk remains a concern.
No trial in trauma-associated thrombocytopenia, despite the review's trauma framing.
Heterogeneous, mostly observational evidence, largely with a non-US drug.

Bottom line: an interesting hypothesis for sepsis-associated thrombocytopenia, not a therapy. Not ready for routine use.

Sources

Morzinski CL, Sorensen DA, Rizzo JA, April MD, Schauer SG. A narrative review of the use of thrombopoietin and thrombopoietin analogues in trauma and critical illness. Med J (Ft Sam Houst Tex). 2025;107(4):55-59. PMID 42658912.