Thrombotic thrombocytopenic purpura medical therapy: Difference between revisions

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__NOTOC__
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{{Xyz}}
{{Thrombotic thrombocytopenic purpura}}
{{CMG}}; {{AE}} {{S.G.}}
{{CMG}}; {{AE}} {{S.G.}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
TTP is a [[medical]] [[emergency]] and requires [[prompt]] treatment. The mainstay of treatment for TTP is [[Blood plasma|plasma]] exchange [[therapy]]. Surgery is recommended among all patients who develop TTP with no responsr to [[medical]] [[therapy]].
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Patients with TTP are treated with daily plasma therapy.<ref name="JolyCoppo2017">{{cite journal|last1=Joly|first1=Bérangère S.|last2=Coppo|first2=Paul|last3=Veyradier|first3=Agnès|title=Thrombotic thrombocytopenic purpura|journal=Blood|volume=129|issue=21|year=2017|pages=2836–2846|issn=0006-4971|doi=10.1182/blood-2016-10-709857}}</ref>
*[[Patient|Patients]] with TTP are treated with daily [[Plasma|plasm]]<nowiki/>a [[Therapy|therap]]<nowiki/>y.<ref name="JolyCoppo2017">{{cite journal|last1=Joly|first1=Bérangère S.|last2=Coppo|first2=Paul|last3=Veyradier|first3=Agnès|title=Thrombotic thrombocytopenic purpura|journal=Blood|volume=129|issue=21|year=2017|pages=2836–2846|issn=0006-4971|doi=10.1182/blood-2016-10-709857}}</ref>
*Patients with TTP are treated with rituximab to prevent complications.<ref name="JolyCoppo2017" />
*[[Patient|Patients]] with TTP are treated with [[rituximab]] to [[Prevention|prevent]] [[Complication (medicine)|complication]]<nowiki/>s.<ref name="JolyCoppo2017" />
===TTP treatment:===
*[[Vincristine]] (VCR) is a agent to treat TTP [[Patient|patients]] resistant to [[Conventional medicine|conventional]] [[plasma]] [[Exchange transfusion|exchange]] (PEX) and [[pharmacologic]] [[therapy]].<ref name="pmid8005232">{{cite journal |vauthors=Bobbio-Pallavicini E, Porta C, Centurioni R, Gugliotta L, Vianelli N, Tacconi F, Billio A, Ascari E |title=Vincristine sulfate for the treatment of thrombotic thrombocytopenic purpura refractory to plasma-exchange. The Italian Cooperative Group for TTP |journal=Eur. J. Haematol. |volume=52 |issue=4 |pages=222–6 |date=April 1994 |pmid=8005232 |doi= |url=}}</ref>
*[[Cyclosporine]] A <ref name="pmid11604563">{{cite journal |vauthors=Medina PJ, Sipols JM, George JN |title=Drug-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome |journal=Curr. Opin. Hematol. |volume=8 |issue=5 |pages=286–93 |date=September 2001 |pmid=11604563 |doi= |url=}}</ref>
===TTP treatment===


**1 '''Plasma therapy'''
**'''Plasma therapy'''
*** (1.53 plasma volume exchange for the first procedures, followed by 1.03 patient plasma volume thereafter)
*** [[Fresh frozen plasma]]([[Fresh frozen plasma|FFP]]) for [[Patient|patients]] who have [[inherited]] TTP
*** [[Plasma]] [[Exchange transfusion|exchange]](PEX) for [[Patient|patients]] who have [[Acquired disorder|acquired]] TTP
*** (1.53 [[plasma]] [[volume]] [[Exchange transfusion|exchange]] for the first procedures, followed by 1.03 [[patient]] [[plasma]] [[volume]] thereafter)
****
****
**'''2 Steroids'''
**'''Steroids'''
***Treatment of acquired TTP is high-dose methylprednisolone
***Treatment of [[acquired]] TTP is high [[dose]] [[methylprednisolone]]
**** [[drug name|Methylprednisolone]] (10 mg/kg/day for 3 days and then 2.5 mg/kg/day), this dose is more efficacious than standard dose (1 mg/kg/day)
**** [[drug name|Methylprednisolone]] (10 mg/kg/day for 3 days and then 2.5 mg/kg/day), this dose is more [[efficacious]] than [[standard]] [[dose]] (1 mg/kg/day)
**'''3Rituximab<ref name="pmid22624596">{{cite journal |vauthors=Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ |title=Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies |journal=Br. J. Haematol. |volume=158 |issue=3 |pages=323–35 |date=August 2012 |pmid=22624596 |doi=10.1111/j.1365-2141.2012.09167.x |url=}}</ref>'''
**'''Rituximab'''
*** Standard treatment(375 mg/m2 in 4 weekly doses)
*** [[Standard]] treatment(375 mg/m2 in 4 weekly [[Dose|doses]])'''<ref name="pmid22624596">{{cite journal |vauthors=Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ |title=Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies |journal=Br. J. Haematol. |volume=158 |issue=3 |pages=323–35 |date=August 2012 |pmid=22624596 |doi=10.1111/j.1365-2141.2012.09167.x |url=}}</ref>'''


==References==
==References==

Latest revision as of 17:02, 31 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

Overview

TTP is a medical emergency and requires prompt treatment. The mainstay of treatment for TTP is plasma exchange therapy. Surgery is recommended among all patients who develop TTP with no responsr to medical therapy.

Medical Therapy

TTP treatment

References

  1. 1.0 1.1 Joly, Bérangère S.; Coppo, Paul; Veyradier, Agnès (2017). "Thrombotic thrombocytopenic purpura". Blood. 129 (21): 2836–2846. doi:10.1182/blood-2016-10-709857. ISSN 0006-4971.
  2. Bobbio-Pallavicini E, Porta C, Centurioni R, Gugliotta L, Vianelli N, Tacconi F, Billio A, Ascari E (April 1994). "Vincristine sulfate for the treatment of thrombotic thrombocytopenic purpura refractory to plasma-exchange. The Italian Cooperative Group for TTP". Eur. J. Haematol. 52 (4): 222–6. PMID 8005232.
  3. Medina PJ, Sipols JM, George JN (September 2001). "Drug-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome". Curr. Opin. Hematol. 8 (5): 286–93. PMID 11604563.
  4. Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ (August 2012). "Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies". Br. J. Haematol. 158 (3): 323–35. doi:10.1111/j.1365-2141.2012.09167.x. PMID 22624596.

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