Thrombotic Thrombocytopenic Purpura: Combined Treatment with Plasmapheresis and Antiplatelet Agents

Abstract

Of 8 patients with thrombotic thrombocytopenic purpura who were treated with exchange plasmapheresis and antiplatelet agents (aspirin and dipyridamole), 7 achieved complete remission. The 8th patient appeared to fail on this regimen but responded to corticosteroids and splenectomy. A 9th patient attained full remission after therapy with aspirin and dipyridamole. The antiplatelet agents appeared to play an important role in the response of 4 patients. Eight patients received maintenance aspirin and dipyridamole. This maintenance therapy may have prevented relapses of thrombotic thrombocytopenic purpura in some patients as evidence of active, subclinical disease persisted for many weeks in most patients. Treatment with maintenance antiplatelet agents was discontinued in 5 patients after 7-18 mo. and no patient has relapsed. An effective therapeutic regimen for thrombotic thrombocytopenic purpura would include initial therapy with exchange plasmapheresis, aspirin and dipyridamole and maintenance therapy with antiplatelet agents.