Prevalence of the age-related diseases in older patients with acquired thrombotic thrombocytopenic purpura

Published:March 19, 2020DOI:


      • The prevalence of older patients with acquired TTP is increasing.
      • There is scarce information on acquired TTP in the elderly.
      • Older TTP patients had a higher prevalence of multimorbidity and polypharmacy.
      • A careful comprehensive geriatric assessment of older TTP patients is necessary.



      The prevalence of older patients with acquired thrombotic thrombocytopenic purpura (TTP) is increasing. There is scarce information on the prevalence of multimorbidity, polypharmacy and age-related diseases in aging TTP patients. This study aimed to evaluate the prevalence of multimorbidity and polypharmacy in a population of acquired TTP patients aged 65 years or more compared with a group of age-matched controls.


      Acquired TTP patients enrolled in the Milan TTP registry from December 1st 1999 to March 31th 2018 and aged 65 years or more at the date of last follow-up were evaluated. Controls were Italian healthy individuals recruited from 2006 to March 31th 2018 among friends and non-consanguineous relatives of patients tested for thrombophilia screening at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center of Milan.


      36 TTP patients and 127 age-matched controls were included. Compared with controls, TTP patients had a higher prevalence of multimorbidity and polypharmacy. They also showed a higher prevalence of autoimmune diseases, osteoporosis and arterial hypertension and were more chronically treated with corticosteroids and antiplatelets for primary cardiovascular prevention. All these results were confirmed after adjusting for sex. Compared with the general elderly population, TTP patients showed a higher prevalence of ischemic heart disease and stroke.


      Our findings suggest that a careful comprehensive geriatric assessment of acquired TTP patients is necessary. It is important to look for other autoimmune diseases and such age-related comorbidities as osteoporosis, arterial hypertension, ischemic heart disease and cerebrovascular disease.



      TTP (thrombotic thrombocytopenic purpura), IQR (interquartile range), CI (confidence interval)
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        • Kennedy A.S.
        • Lewis Q.F.
        • Scott J.G.
        • et al.
        Cognitive deficits after recovery from thrombotic thrombocytopenic purpura.
        Transfusion. 2009; 49: 1092-1101
        • Ambadwar P.
        • Duvall D.
        • Wolf N.J.
        • Terrell D.R.
        • Vesely S.K.
        • George J.N
        Support groups for patients who have recovered from thrombotic thrombocytopenic purpura.
        J Clin Apher. 2008; 23: 168-169
      1. Riva S., Mancini I., Maino A. et al. Long-term neuropsychological sequelae, emotional wellbeing and quality of life in patients with acquired thrombotic thrombocytopenic purpura. Haematologica. 2019Sep 26. pii: haematol.2019.226423. doi: 10.3324/haematol.2019.226423. [Epub ahead of print].

        • Deford C.C.
        • Reese J.A.
        • Schwartz L.H.
        • et al.
        Multiple major morbidities and increased mortality during long-term follow-up after recovery from thrombotic thrombocytopenic purpura.
        Blood. 2013; 122: 2023-2029
        • Cataland S.R.
        • Scully M.A.
        • Paskavitz J.
        • et al.
        Evidence of persistent neurologic injury following thrombotic thrombocytopenic purpura.
        Am J Hematol. 2011; 86: 87-89
        • Falter T.
        • Schmitt V.
        • Herold S.
        • et al.
        Depression and cognitive deficits as long-term consequences of thrombotic thrombocytopenic purpura.
        Transfusion. 2017; 57: 1152-1162
        • Coppo P.
        • Bengoufa D.
        • Veyradier A.
        • et al.
        Severe ADAMTS13 deficiency in adult idiopathic thrombotic microangiopathies defines a subset of patients characterized by various autoimmune manifestations, lower platelet count, and mild renal involvement.
        Medicine (Baltimore). 2004; 83: 233-244
        • John M.L.
        • Scharrer I.
        Autoimmune disorders in patients with idiopathic thrombotic thrombocytopenic purpura.
        Hamostaseologie. 2012; 32: S86-S89
        • Viswanathan S.
        • Rovin B.H.
        • Shidham G.B.
        • et al.
        Long-term, sub-clinical cardiac and renal complications in patients with multiple relapses of thrombotic thrombocytopenic purpura.
        Br J Haematol. 2010; 149: 623-625
        • Patschan D.
        • Witzke O.
        • Dührsen U.
        • Erbel R.
        • Philipp T.
        • Herget-Rosenthal S
        Acute myocardial infarction in thrombotic microangiopathies–clinical characteristics, risk factors and outcome.
        Nephrol Dial Transplant. 2006; 21: 1549-1554
        • Hawkins B.M.
        • Abu-Fadel M.
        • Vesely S.K.
        • George J.N.
        Clinical cardiac involvement in thrombotic thrombocytopenic purpura: a systematic review.
        Transfusion. 2008; 48: 382-392
      2. Prevel R., Roubaud-Roubaud C., Gourlain S. et al. Prognostic and long-term survival of immune thrombotic thrombocytopenic purpura in older patients. Blood. 2019Sep 17. pii: blood.2019000748. doi: 10.1182/blood.2019000748. [Epub ahead of print].

        • Mancini I.
        • Pontiggia S.
        • Palla R.
        • et al.
        Clinical and laboratory features of patients with acquired thrombotic thrombocytopenic purpura: fourteen years of the Milan TTP Registry.
        Thromb Haemost. 2019; 119: 695-704
        • Lotta L.A.
        • Wang M.
        • Yu J.
        • et al.
        Identification of genetic risk variants for deep vein thrombosis by multiplexed next-generation sequencing of 186 hemostatic/pro-inflammatory genes.
        BMC Med Genomics. 2012; 5: 7
        • Guisado-Clavero M.
        • Violán C.
        • López-Jimenez T.
        • et al.
        Medication patterns in older adults with multimorbidity: a cluster analysis of primary care patients.
        BMC Fam Pract. 2019; 20: 82
        • Aubert C.E.
        • Schnipper J.L.
        • Fankhauser N.
        • et al.
        Patterns of multimorbidity associated with 30-day readmission: a multinational study.
        BMC Public Health. 2019; 19: 738
        • Masnoon N.
        • Shakib S.
        • Kalisch-Ellett L.
        • Caughey G.E
        What is polypharmacy? a systematic review of definitions.
        BMC Geriatr. 2017; 17: 230
        • Limongi F.
        • Noale M.
        • Crepaldi G.
        • Maggi S.
        • Working Group I.L.S.A.
        Prevalence of diabetes and depressive symptomatology and their effect on mortality risk in elderly italians: the italian longitudinal study on aging.
        Diabetes Metab. 2014; 40: 373-378
        • Agborsangaya C.B.
        • Ngwakongnwi E.
        • Lahtinen M.
        • Cooke T.
        • Johnson J.A.
        Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering.
        BMC Public Health. 2013; 13: 1161
        • Marengoni A.
        • Angleman S.
        • Melis R.
        • et al.
        Aging with multimorbidity: a systematic review of the literature.
        Ageing Res Rev. 2011; 10: 430-439
        • Slater N.
        • White S.
        • Venables R.
        • Frisher M.
        Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from the english longitudinal study of ageing (ELSA).
        BMJ Open. 2018; 8e020270
        • Benjamin E.J.
        • Blaha M.J.
        • Chiuve S.E.
        • et al.
        Heart disease and stroke statistics-2017 update: a report from the american heart association.
        Circulation. 2017; 135: e146-e603
        • Motta M.
        • Bennati E.
        • Ferlito L.
        • et al.
        Cardio-cerebrovascular complications in elderly with diabetes.
        Arch Gerontol Geriatr. 2007; 44: 261-269