Second-line medical therapies Second-line medical therapies are available for patients with immune thrombocytopenia Who are seeking to defer splenectomy in hope of a spontaneous remission Who are not candidates for or refuse splenectomy In whom splenectomy has not been effective Such patients usually have platelet counts < 10, 000 to 20, 000 / mcL (< 10 to 20 × 10 9 / L), and thus are at risk for bleeding.