Among patients with immune thrombotic thrombocytopenic purpura (iTTP), there may frequently be evidence of brain infarction using magnetic resonance imaging (MRI), according to research presented at 2022 ASH Annual Meeting.

Previous research has shown that patients who survive iTTP have an increased risk of cardiovascular events. Stroke, in particular, is linked with low-remission ADAMTS13 levels, suggesting that clinicians should be aware of this risk among those who survive iTTP.

MRI evaluation of survivors of iTTP may help in this endeavor. For the Neurologic Sequelae of TTP trial, researchers are using MRI to evaluate the incidence rates of silent cerebral infarction (SCI), which are ischemic lesions that are known to predict for stroke occurrence. The authors also aim to determine risk factors for SCI, and whether SCI predicts cognitive impairment.


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All patients enrolled to this prospective study were adults aged at least 18 years, who had iTTP as determined by ADAMTS13 activity of less than 10% during an acute disease episode. Patients are followed up with annually.

Overall, 39 patients were enrolled through July 2022, and 32 patients completed MRI evaluation. The median patient age was 48 years, 71% of patients were female sex, and 23% of patients had survived a previous stroke.

Analysis showed that SCI occurred in 53.1% of cases on MRI evaluation; of these, 47% had had previous stroke. Predictors for SCI on logistic regression included age (odds ratio [OR], 1.07; P =.025) and history of stroke (OR, 12.8; P =.044). Hypertension, however, was not a predictor (OR, 0.77; P =.768).

Furthermore, the researchers noted that mild and major cognitive impairment were present in 23.1% and 30.8% of patients, respectively. Patients with SCI had higher rates of cognitive impairment overall (70.5% vs 26.7% among those without SCI), as well as major cognitive impairment (52.9% vs 6.7%, respectively; P =.014).

Patients with SCI had lower scores when tested for executive function and processing speed (both P =.004). Depression scores were not, however, higher in the SCI group.

“MRI evidence of brain infarction is common in patients with iTTP with or without a clinical history of stroke,” the authors noted in their presentation. “Ongoing follow up with serial MRI continues and will inform whether SCI are progressive in remission and whether low remission ADAMTS13 is a targetable risk factor.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Yu J, Brown J, Salzberg E, et al. Silent cerebral infarction during immune TTP remission – prevalence, predictors and impact on cognition. Presented at ASH 2022. December 10-13, 2022. Abstract 138.