TPO and Portal vein thrombosis: TPO-RAs have emerged as alternative treatment options, including romiplostim, eltrombopag, avatrombopag, and lusutrombopag [14,15]. However, their use in ESLD is associated with significant risks [16]. A study done by Yu et al. demonstrated that combining TPO-RA with dexamethasone results in a high response rate [17]. However, certain TPO-RAs, particularly eltrombopag, carry an increased risk of thromboembolic complications, including portal vein thrombosis, especially in patients with ESLD [16].