Successful management of refractory immune-mediated thrombotic thrombocytopenic purpura during pregnancy and delivery using the anti-VWF nanobody caplacizumab.

Schimmer, Roman R; Sutter, Tabea; Bachofner, Adrian; Ranieri, Elisabetta; Rodewald, Ann-Kathrin; Kremer Hovinga, Johanna A; Kimmich, Nina; Trinchero, Alice; Studt, Jan-Dirk (2024). Successful management of refractory immune-mediated thrombotic thrombocytopenic purpura during pregnancy and delivery using the anti-VWF nanobody caplacizumab. (In Press). British journal of haematology Wiley-Blackwell 10.1111/bjh.19284

Text Br_J_Haematol_-_2024_-_Schimmer_-_Successful_management_of_refractory_immune_mediated_thrombotic_thrombocytopenic_purpura.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (2MB) | Request a copy

Pregnancy is a potential trigger of acute thrombotic thrombocytopenic purpura (TTP). The management of pregnancy-associated immune-mediated TTP (iTTP) can be challenging, especially when it is refractory to standard treatment. Caplacizumab, a nanobody to von Willebrand factor (VWF) blocking its A1 domain, is a valuable new therapeutic option. Its use is, however, not approved during pregnancy and breastfeeding. We describe the successful off-label administration of caplacizumab during pregnancy and delivery in a patient with refractory iTTP. The favourable outcome without significant thrombotic or haemorrhagic complications indicates that caplacizumab may be an effective and safe treatment option in refractory iTTP during pregnancy.

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