Recent studies have shown that thrombopoiesis stimulating molecules improve platelet counts in chronic refractory idiopathic thrombocytopenic purpura (ITP). Busser and colleagues performed a randomized dose escalating trial of eltrombopag, an oral thrombopoietin stimulating agent, vs placebo for chronic ITP. The three doses of 30 mg, 50 mg, and 75 mg daily that were investigated led to platelet counts above 50,000 per uL in 28%, 70% and 81% respectively. Toxicities were similar to placebo. Eltrombopag is an oral thrombomimetic with considerable activity in chronic ITP that warrants further clinical study.