Management of immune TTP without plasma exchange: lessons learned from the Austrian experience

Paul Knoebl, M.D.
Medical University of Vienna
Vienna, Austria

Therapeutic plasma exchange (TPE) has been a standard treatment for immune thrombotic thrombocytopenic purpura (TTP), but recent experience suggests it may not always be necessary. In this presentation, Paul Knoebl discusses an Austrian strategy where caplacizumab and immunosuppression were used without TPE if platelet counts increased after the first dose of caplacizumab. Among 34 patients, 88% showed rapid platelet recovery and resolution of organ dysfunction without the need for TPE. In 12% of patients, additional TPE was required. Of these, 97% achieved clinical response and all achieved ADAMTS13 remission. These results support a TPE-free approach for most cases of acute TTP managed with caplacizumab and immunosuppression.