Thrombotic Thrombocytopenic Purpura (TTP) Medication

Updated: Sep 25, 2017
  • Author: Theodore Wun, MD, FACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Medication

Medication Summary

Generally, drug therapy in thrombotic thrombocytopenic purpura (TTP) is reserved for patients with refractory disease. Some hematologists routinely treat patients with steroids, and given the data that acquired TTP may be an autoimmune disorder with an inhibitory antibody to von Willebrand factor (vWF)-cleaving protease, this practice has appeal.

The chemotherapeutic agent vincristine has been used as an adjunct to plasma exchange in patients with refractory disease, but its routine use has not been validated. Recent case reports have suggested that cyclosporine may be beneficial in patients with refractory disease even though this drug has been incriminated as a potential trigger of TTP. [28] Although used in the past, aspirin and dipyridamole are no longer used in treating TTP.

The anti-CD20 monoclonal antibody rituximab has been reported to have activity in patients' refractory to plasma exchange. A study by Scully et al found that weekly rituximab given within 3 days of acute admission for TTP was safe and effective, with reduced stay and relapse. [29] A study by Froissart and colleagues, in 22 adult patients who had responded poorly to plasma exchange, found that treatment with rituximab resulted in shorter overall treatment duration and reduced 1-year relapses, compared with historical controls. [20]

Rituximab is typically given in a dosage of 375 mg/m2 weekly for 4 weeks. Ideally, at least 4 hours should elapse between administration of rituximab and plasma exchange. [14]

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Blood Products

Class Summary

Plasma exchange with FFP is the therapy of choice for TTP.Fresh frozen plasma (FFP, Octaplas)

Fresh frozen plasma (FFP, Octaplas)

Plasma provides all plasma proteins and clotting factors to support adequate hemostasis to treat or prevent bleeding or to treat other protein deficiencies that cannot be replaced with protein specific concentrates. It is indicated for plasma exchange in patients with TTP. Octaplas is a solvent detergent treated, pooled FFP.

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Chemotherapy agents

Class Summary

These agents are used as an adjunct to plasma exchange.

Vincristine (Oncovin, Vincasar)

Mechanism of action uncertain. May involve a decrease in reticuloendothelial cell function or increase in platelet production. However, neither of these mechanisms fully explains the effect in TTP and HUS.

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Corticosteroids

Class Summary

These agents are used to treat idiopathic and acquired autoimmune disorders. They are also used as an adjunct to plasma exchange.

Prednisone (Sterapred)

May work by decreasing activity of reticuloendothelial system. In light of the evidence that patients with acquired TTP have an inhibitor to vWF-cleaving protease, steroids may decrease production of autoantibody.

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Monoclonal antibody

Class Summary

These agents have shown efficacy in the treatment of autoimmune disorders.

Rituximab (Rituxan)

Anti-CD20 chimeric monoclonal antibody initially approved for therapy of follicular lymphoma. Has been shown to have activity in several autoimmune disorders such as immune thrombocytopenia, systemic lupus erythematosus, autoimmune hemolytic anemia, and rheumatoid arthritis.

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