Among patients with immune thrombotic thrombocytopenic purpura (iTTP), older age, hypertension, smoking, and high plasma concentrations of anti-ADAMTS13 IgG appear to be linked with cerebral infarction risk, according to research published in TH Open.

iTTP, a rare and dangerous hematologic disorder characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, and organ injury, may occur in conjunction with thrombotic events, including ischemic cerebral infarction.

Patients with iTTP may present with neurologic symptoms, and the diagnosis must be confirmed by measuring plasma ADAMTS13 activity or anti-ADAMTS13 IgGs concentration. For this study, researchers attempted to determine the frequency of and any risk factors linked with ischemic stroke in patients with iTTP.

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Overall, of 109 confirmed iTTP diagnoses, 66 (60.5%) patients presented with neurologic complaints. The mean patient age was 45.2 years, 33 (50%) patients were women, and 49 (74.2%) were Black; 40 (60.6%) patients had hypertension, 27 (48.2%) were smokers, and 16 (24.2%) had diabetes mellitus. Fourteen (21.2%) patients presenting with neurologic symptoms, moreover, did not undergo neuroimaging during hospitalization.

Of the patients with neurologic complaints, 44 had a confirmed ischemic stroke. Statistical analysis suggested that hypertension (81.8% in patients with stroke vs 50% without; P =.027) and smoking status (72.2% stroke occurrence in smokers vs 36.8% in non-smokers; P =.021) were predictive of stroke risk. Patients with ischemic stroke also tended to be older (mean age of patients with stroke, 48.7 years vs 43.4 years in those without stroke) and to have higher plasma concentrations of anti-ADAMTS13 IgG.

Gender, ethnicity, presence of diabetes mellitus, and blood group did not appear to predict stroke incidence.

“In conclusion, our present study demonstrates a proof of concept that patients with acute iTTP who present with neurological signs and symptoms may have a higher incidence of ischemic stroke than we have previously known,” the authors wrote.

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Memon R, Sui J, Lin C, Zheng XL. Cerebral infarction in immune thrombotic thrombocytopenic purpura is associated with old age, hypertension, smoking, and anti-ADAMTS13 Ig, but not with mortality. TH Open. 2021;5(1):e1-e7. doi:10.1055/s-0040-1722610