Objective To determine the efficacy of recombinant human thrombopoietin in the treatment of thrombocytopenia in the elderly patients with synovial sarcoma after chemotherapy. Methods Sixty elder patients with pathologically verified synovial sarcoma admitted in our Orthopedic Department during April 2011 and June 2015 were enrolled in this study. They were randomized into Group A and Group B, and were all treated with MAID chemotherapy (mesna, doxorubicin, ifosfamide, and dacarbazine). The patients from Group A did not receive recombinant human thrombopoietin in the first cycle of chemotherapy, but received within 24 h after the end of second cycle, at the dose of 15000U/d for 7 consecutive days or till the peripheral platelet count ≥100×109/L. For the patients of Group B, the protocol of thrombopoietin treatment was opposite to that of Group A. The interval of 2 cycles of chemotherapy was 14-21 d. The second cycle of thermotherapy started only when all the blood indicators were in the normal ranges. The patients were given platelet transfusion when the blood platelet count ≤25×109/L. Other adjuvant treatments were consistent between the groups. Minimal platelet count, recovery maximal platelet count, recovery time, duration to platelet count≤50×109/L, platelet transfusion times and units were recorded to evaluate the efficacy. Results (1) No significant differences were observed in baseline data between the 2 groups (P>0.05). (2) Minimal platelet counts were elevated (P<0.05), but maximal platelet counts remained unchanged in the thrombopoietin treatment group during both chemotherapy cycles (P>0.05). Recovery time, duration to platelet count≤50×109/L, and platelet transfusion times and units were decreased significantly in the treatment group than in the control group (P<0.05). (3) Minimal platelet counts were increased (P<0.05) and maximal platelet counts remained the same in the treatment cycle of both groups (P>0.05). Recovery time, duration to platelet counts ≤50×109/L, and platelet transfusion times and units were reduced remarkably in the treatment cycle than the un-treatment cycle in both groups (P<0.05). Conclusion Recombinant human thrombopoietin effectively promotes the platelet counts in the elder synovial sarcoma patients after chemotherapy, and improves the patients to accept optimal doses of chemotherapeutic drugs for better overall efficacy. It is safe and of few side effects, and thus worth of extensive clinical application.