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ADAMTS13 and anti-ADAMTS13 antibodies as markers for recurrence of acquired thrombotic thrombocytopenic purpura during remission

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Organization
Abstract
Background : From 20 to 50% of patients who survive an acute episode of the acquired form of thrombotic thrombocytopenic purpura relapse but clinical and laboratory markers of recurrence are not well established. Design and Methods : In 109 patients enrolled in an international registry we evaluated, in the frame of a retrospective cohort study, the predictive role of the metalloprotease ADAMTS13 as measured in plasma during remission. Anti-ADAMTS13 antibodies and von Willebrand factor were also evaluated in a smaller number of the same patients. Results : Median values of ADAMTS13 activity and antigen were significantly lower in patients with recurrent thrombotic thrombocytopenic purpura than in those with no recurrence (activity: 12% vs. 41%; p=0.007; antigen: 36% vs. 58%; p=0.003). A severe deficiency of ADAMTS13 activity (10% or less) was associated with a higher likelihood of recurrence (odds ratio 2.9; 95% confidence interval 1.3 to 6.8; p=0.01). Anti-ADAMTS13 antibodies were also more prevalent in patients with recurrent thrombotic thrombocytopenic purpura (odds ratio 3.1; 95% confidence interval 1.4 to 7.3; p=0.006). The presence during remission of both severe ADAMTS13 deficiency and anti-ADAMTS13 antibodies increased the likelihood of recurrence 3.6 times (95% confidence interval 1.4 to 9.0; p=0.006). The presence of ultralarge von Willebrand factor multimers and of associated diseases or conditions did not increase recurrence. Conclusions : Survivors of an acute episode of acquired thrombotic thrombocytopenic purpura with severely reduced levels of ADAMTS13 and/or with anti-ADAMTS13 antibodies during remission have an approximately three-fold greater likelihood of developing another episode of thrombotic thrombocytopenic purpura than patients with higher protease activity and no antibody.
Keywords
thrombotic thrombocytopenic purpura, ADAMTS13, von Willebrand factor, risk factors, recurrence, VON-WILLEBRAND-FACTOR, FACTOR-CLEAVING PROTEASE, HEMOLYTIC-UREMIC SYNDROME, PLASMA-EXCHANGE, MICROANGIOPATHIES, METALLOPROTEASE, AUTOANTIBODIES, DISEASE, TTP, DEFICIENT

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Chicago
Peyvandi, Flora, Silvia Lavoretano, Roberta Palla, Hendrik Feys, Karen Vanhoorelbeke, Tullia Battaglioli, Carla Valsecchi, et al. 2008. “ADAMTS13 and anti-ADAMTS13 Antibodies as Markers for Recurrence of Acquired Thrombotic Thrombocytopenic Purpura During Remission.” Haematologica-the Hematology Journal 93 (2): 232–239.
APA
Peyvandi, Flora, Lavoretano, S., Palla, R., Feys, H., Vanhoorelbeke, K., Battaglioli, T., Valsecchi, C., et al. (2008). ADAMTS13 and anti-ADAMTS13 antibodies as markers for recurrence of acquired thrombotic thrombocytopenic purpura during remission. HAEMATOLOGICA-THE HEMATOLOGY JOURNAL, 93(2), 232–239.
Vancouver
1.
Peyvandi F, Lavoretano S, Palla R, Feys H, Vanhoorelbeke K, Battaglioli T, et al. ADAMTS13 and anti-ADAMTS13 antibodies as markers for recurrence of acquired thrombotic thrombocytopenic purpura during remission. HAEMATOLOGICA-THE HEMATOLOGY JOURNAL. 2008;93(2):232–9.
MLA
Peyvandi, Flora, Silvia Lavoretano, Roberta Palla, et al. “ADAMTS13 and anti-ADAMTS13 Antibodies as Markers for Recurrence of Acquired Thrombotic Thrombocytopenic Purpura During Remission.” HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 93.2 (2008): 232–239. Print.
@article{8549109,
  abstract     = {Background : From 20 to 50\% of patients who survive an acute episode of the acquired form of thrombotic thrombocytopenic purpura relapse but clinical and laboratory markers of recurrence are not well established. 
Design and Methods : In 109 patients enrolled in an international registry we evaluated, in the frame of a retrospective cohort study, the predictive role of the metalloprotease ADAMTS13 as measured in plasma during remission. Anti-ADAMTS13 antibodies and von Willebrand factor were also evaluated in a smaller number of the same patients. 
Results : Median values of ADAMTS13 activity and antigen were significantly lower in patients with recurrent thrombotic thrombocytopenic purpura than in those with no recurrence (activity: 12\% vs. 41\%; p=0.007; antigen: 36\% vs. 58\%; p=0.003). A severe deficiency of ADAMTS13 activity (10\% or less) was associated with a higher likelihood of recurrence (odds ratio 2.9; 95\% confidence interval 1.3 to 6.8; p=0.01). Anti-ADAMTS13 antibodies were also more prevalent in patients with recurrent thrombotic thrombocytopenic purpura (odds ratio 3.1; 95\% confidence interval 1.4 to 7.3; p=0.006). The presence during remission of both severe ADAMTS13 deficiency and anti-ADAMTS13 antibodies increased the likelihood of recurrence 3.6 times (95\% confidence interval 1.4 to 9.0; p=0.006). The presence of ultralarge von Willebrand factor multimers and of associated diseases or conditions did not increase recurrence. 
Conclusions : Survivors of an acute episode of acquired thrombotic thrombocytopenic purpura with severely reduced levels of ADAMTS13 and/or with anti-ADAMTS13 antibodies during remission have an approximately three-fold greater likelihood of developing another episode of thrombotic thrombocytopenic purpura than patients with higher protease activity and no antibody.},
  author       = {Peyvandi, Flora and Lavoretano, Silvia and Palla, Roberta and Feys, Hendrik and Vanhoorelbeke, Karen and Battaglioli, Tullia and Valsecchi, Carla and Canciani, Maria Teresa and Fabris, Fabrizio and Zver, Samo and R{\'e}ti, Marienn and Mikovic, Danijela and Karimi, Mehran and Giuffrida, Gaetano and Laurenti, Luca and Mannucci, Pier Mannuccio},
  issn         = {0390-6078},
  journal      = {HAEMATOLOGICA-THE HEMATOLOGY JOURNAL},
  language     = {eng},
  number       = {2},
  pages        = {232--239},
  title        = {ADAMTS13 and anti-ADAMTS13 antibodies as markers for recurrence of acquired thrombotic thrombocytopenic purpura during remission},
  url          = {http://dx.doi.org/10.3324/haematol.11739},
  volume       = {93},
  year         = {2008},
}

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