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Wolfgang Miesbach: iTTP Remission ≠ Cure. The Vascular Injury Persists
Wolfgang Miesbach/LinkedIn
Dec 7, 2025, 05:50

Wolfgang Miesbach: iTTP Remission ≠ Cure. The Vascular Injury Persists

Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared on LinkedIn:

“iTTP remission ≠ cure. The vascular injury persists. TTP as a cardiovascular disease equivalent. Just finished Dr. Senthil Sukumar‘s ASH25 session on long-term iTTP management. This completely changed how I think about these patients.

Wolfgang Miesbach: iTTP Remission ≠ Cure. The Vascular Injury Persists

The Numbers Hit Different:

  • 28.6% of survivors → major cardiovascular events
  • 50% → silent cerebral infarcts (vs 16.6% controls)
  • Cardiovascular complications 10–20 years EARLIER
  • 80% depression | 35% post traumatic stress disorder
  • >60% measurable neurocognitive impairment
  • 71% moderate-severe headaches
  • 20% can’t work due to complications

The Game Changer: Endothelial Damage That Doesn’t Heal
Patients are not ‘fine’ after remission. The endothelium stays injured. Stress cardiac MRI shows reduced perfusion + impaired coronary vasodilation—the heart can’t increase blood flow under stress even when ADAMTS13 normalizes.

The Actionable Part 💡
ADAMTS13 ≤70% = 27.6% stroke rate
ADAMTS13 >70% = ZERO ischemic strokes

As a consequence, treat iTTP as CVD Equivalent

  • Comprehensive cardiovascular risk factor optimization (lipids, A1C, smoking, BP, weight, activity)
  • Baseline mood + neurocognitive screening for ALL survivors
  • Neuropsych testing every 1–2 years
  • Multidisciplinary teams (neuro, psych, cardio)”

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A1C activity ADAMTS13 ASH2025 ASH25 BP Cardiovascular Complications Dr. Senthil Sukumar Health Hematology Hemostasis Hemostasis Today iTTP lipids major cardiovascular events Medicine MRI neurocognitive impairment silent cerebral infarcts smoking weight
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