Smoking has been associated with cardiovascular disease and there is evidence that this might be mediated by the increased production of thromboxane. Whether metabolites of thromboxane, such as 11-dehydro-thromboxane B2 (TXB2), could be used as a biomarker of risk in the assessment of candidate modified risk tobacco products (MRTPS) is not clear. The aim of this literature review and meta-analysis (MA) was to determine the association of smoking status and TXB2 levels. Additionally we evaluated the effect of smoking cessation and the use of a tobacco heated system (THS) currently in development, to urinary levels of 11-dehydro-thromboxane B2.