Background and aims: In most patients with ITP, the increased risk of thrombosis is small (relative risk < 2) and not sufficient to influence management.  However, more recent studies suggest that certain subpopulations of patients with ITP may be at a significantly higher risk of thrombotic complications. These include patients who have undergone splenectomy, Patients older than 60 years are also at increased risk of thromboembolism, The presence of antiphospholipid antibodies (aPL) has been observed in a substantial proportion of ITP patients and there is increased thrombotic risk associated with thrombopoietin receptor agonists. The aim of this study is to assess the incidence of thrombotic complications in immune thrombocytopenic purpura and to identify the possible risk factors. Methods: we performed a retrospective study including 52 patients with primary immune thrombocytopenia ≥18 years old , The patients were selected from Ain Shams University Department of Internal Medicine Clinical Hematology and Oncology Division outpatient clinic, Cairo, Egypt in the period from January 2018 to July 2018. results: 10 patients out of 52 developed thrombosis representing one fifth of total cases (19.23 %) 6 of them developed venous thromboembolism and 4 developed arterial thrombosis. All of them were chronic ITP patients (P-value 0.038*), 4 patients out of 10 who developed thrombosis were using revolade (TPO RA) (P-value 0.016*), the 2 patients who underwent splenectomy developed arterial thrombosis (P-value 0.003*), 2 out of the 10 patients who developed thrombosis had hereditary causes of thrombophilia (P-value 0.003*). Conclusion: there is an increased risk of thromboembolism in patients with primary immune thrombocytopenia especially in those who underwent splenectomy and those using TPO RA.