The TMA team and TTP pathway improved outcomes in a cohort with Thrombotic thrombocytopenic purpura

All patients had acquired TTP. TTP-RRD at 90 days was reduced from 69% with usual care to 6% with Pathway care (95% CI 0.35 to 0.90, P = 0.0004), a relative risk reduction of 91%; TTP relapse alone at 90 days was reduced from 62% to 0% (95% CI 0.36 to 0.88, P = 0.0002) with Pathway care. The number needed to treat to prevent TTP-RRD was 1.59 at 90 days. Over the project duration usual care demonstrated a hazard ratio for TTP-RRD of 12.58 compared to Pathway care. With the intervention, the duration of TPE was increased (median 6 vs 12 sessions, P < 0.05), as was use of rituximab (31.3% vs 93.8%, 95% CI -0.36 to -0.88, P = 0.003), and caplacizumab (6.3% vs 62.5%, 95% CI -0.027 to -0.81, P = 0.001). All Pathway patients underwent biochemical surveillance, and 31% had pre-emptive rituximab to reduce possibility of clinical relapse. A structured TTP Pathway significantly reduces morbidity and aligns care with modern clinical guidelines. The TMA Team is a valuable institutional resource to improve outcomes.