Current therapeutic approach for adults with ITP: a multistep algorithm. The therapies included in the 3 categories may vary according to availability, clinician experience, and cost. Switching to the next line can be carried out before exhausting all options. *Used for patients with active serious bleeding or high risk of bleeding. **Rituximab can be used prior to TPO-RA if the patient places a high value on limiting the duration of therapy or if TPO-RA is not advised because of the risk of thromboembolism. ˆFostamatinib can be used off-label prior to TPO-RA if TPO-RA is not advised because of the risk of thromboembolism. ″Dapsone and danazol can be used in countries where alternative treatment is not available. #Investigational products should be considered in all stages, not only for refractory ITP; many combination therapies have shown promising results in the first- and second-line but are currently not considered as standard treatment. §Splenectomy is still an option that can be considered among second-line treatments, although it is recommended to delay it until at least 1 year after ITP onset. IVIg, IV immunoglobuli; MMF, mycophenolate mofetil; TOP-RA, thrombopoietin receptor agonist.