In a study by Loffredo et al., ESLD patients treated with eltrombopag had a higher incidence of thromboembolic events, including portal vein thrombosis, than controls [16]. These findings highlight the need for cautious use of TPO-RA in ESLD, particularly in patients with preexisting thrombotic risk factors or portal hypertension. This evidence concerns the gene TPO and portal hypertension.