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.
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)”
Get the latest from Hemostasis Today.
-
May 12, 2026, 16:46Tagreed Alkaltham: Why Apheresis Matters in Modern Transfusion Medicine
-
May 12, 2026, 16:37Reinhold Kreutz: Cardiovascular Burden in Acute Intermittent Porphyria Needs Greater Awareness
-
May 12, 2026, 16:33Pablo Corral: The Truth About Very Low LDL-Cholesterol
-
May 12, 2026, 16:24Mildred Lundgren: We Must Talk About the Invisible Causes of Stroke
-
May 12, 2026, 16:17Irene Scala: The Sex Disparities In Access to Acute Stroke Treatments In Italy
-
May 12, 2026, 16:04May Nour: UCLA Health Mobile Stroke Unit Becomes The 1st In The World to Perform mCTA In the Field
-
May 12, 2026, 15:57Leonardo Roever: Prognostic Impact of Lipoprotein(a) and CAR in Elderly Acute Ischemic Stroke Patients
-
May 12, 2026, 15:54Bruno Pougault: Prioritizing Laboratory Tests in Resource-Limited Emergency Care
-
May 12, 2026, 15:37Jennifer Holter Chakrabarty: Supporting the Next Generation of Hematology Researchers