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)”
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