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Thrombotic Thrombocytopenic Purpura: A Missed Cause in Stroke Prevention Guidelines
Adrien Picod1,2, Bérangère S Joly2,3,4, Agnès Veyradier2,3,4
1Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France (A.P.).
Insights
The 2024 stroke prevention guidelines omit crucial advice for thrombotic thrombocytopenic purpura patients. Including specific recommendations and ADAMTS13 testing could prevent strokes in this vulnerable group.
Area of Science:
- Neurology
- Hematology
- Cardiovascular Medicine
Background:
- The 2024 Guidelines for the Primary Prevention of Stroke highlight modifiable risk factors for cerebrovascular disease.
- Current guidelines address hypertension, diabetes, atherosclerotic disease, and genetic stroke predispositions.
- Thrombotic thrombocytopenic purpura (TTP) patients face a high risk of stroke, often its primary manifestation.
Purpose of the Study:
- To identify omissions in the 2024 stroke prevention guidelines.
- To advocate for the inclusion of specific recommendations for TTP patients.
- To emphasize the importance of ADAMTS13 activity measurement in cryptogenic stroke workup.
Main Methods:
- Review of the 2024 American Heart Association/American Stroke Association stroke prevention guidelines.
- Analysis of the established link between TTP and ischemic stroke.
- Evaluation of potential preventive interventions for TTP-related thrombotic events.
Main Results:
- The 2024 guidelines lack specific recommendations for patients with thrombotic thrombocytopenic purpura.
- Stroke is a significant risk and potential sole manifestation of TTP.
- ADAMTS13 activity testing is proposed for cryptogenic stroke evaluation.
Conclusions:
- Future stroke prevention guidelines must incorporate specific recommendations for TTP patients.
- Early identification and management of TTP are critical for stroke prevention.
- Considering ADAMTS13 testing can aid in diagnosing stroke causes in TTP patients.
Abstract:
The 2024 Guidelines for the Primary Prevention of Stroke, recently updated by the American Heart Association and the American Stroke Association, serve as an essential resource for clinicians aiming to reduce the growing impact of cerebrovascular disease. These guidelines emphasize modifiable risk factors and population-specific considerations, covering a range of cardiovascular conditions, including hypertension, diabetes, atherosclerotic disease, and genetic predispositions to stroke. However, a notable omission in these guidelines is the absence of specific recommendations for patients with thrombotic thrombocytopenic purpura. Indeed, these patients are particularly susceptible to stroke, which can be the sole manifestation of the disease. Given the established association between thrombotic thrombocytopenic purpura and ischemic stroke and the effectiveness of preventive interventions, future guidelines should include specific recommendations for patients with thrombotic thrombocytopenic purpura to avert thrombotic events, including stroke. In that regard, ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) activity measurement should be considered in the workup of cryptogenic stroke.
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