Which salvage strategies are used in the management of thrombotic thrombocytopenic purpura (TTP)?

Updated: Nov 30, 2019
  • Author: Perumal Thiagarajan, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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In more severe cases, salvage strategies may include twice-daily therapeutic plasma exchange, pulses of cyclophosphamide, and vincristine. [33] Anecdotal reports indicate cases of TTP responding to a variety of therapies, including the following:

  • IVIG
  • Recombinant ADAMTS13 [33]
  • Inhibitors of the glycoprotein-Ib/IX-von Willebrand factor axis [33]
  • Staphylococcal protein A adsorption
  • N-acetylcysteine [34]
  • Intravenous bortezomib [35]

Patients who relapse frequently or patients who require large volumes of replacement therapy are candidates for splenectomy. Splenectomy decreases the rate of relapse in patients with chronic relapsing forms of the disease.

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