Garabet L, Henriksson CE, Lozano ML, et al. - Researchers examined the involvement of endothelial cell activation and neutrophil extracellular traps (NETs) in the hypercoagulable state of immune thrombocytopenia (ITP) and assessed if thrombopoietin-receptor-agonists (TPO-RAs)-treatment intensifies endothelial cell activation and NET formation. They examined 21 ITP patients for markers of endothelial cell activation including intercellular adhesion molecule-1, vascular adhesion molecule-1 and thrombomodulin and 18 ITP patients regarding E-selectin. Fifteen ITP patients were assessed for Markers of NET formation, citrullinated histone H3-DNA and cell-free DNA. Measurement of all markers was done before, and 2 and 6 weeks after initiation of TPO-RA-treatment in ITP patients, and in matched controls. The analysis revealed that among ITP patients, endothelial cell activation and NET formation increases, both of which may contribute to the intrinsic hypercoagulable state of ITP. However, TPO-RA-treatment seemed not further increasing endothelial cell activation or NET formation. This suggests the involvement of other drug-associated prothrombotic mechanisms.