Magnesium Sulfate in Thrombotic Thrombocytopenic Purpura in Intensive Care
Status:
Active, not recruiting
Trial end date:
2021-12-01
Target enrollment:
Participant gender:
Summary
Thrombotic Thrombocytopenic Purpura (TTP) is a potentially life-threatening thrombotic
microangiopathy caused by a severe deficiency of ADAMTS13 (a disintegrin and
metalloproteinase with a thrombospondin type 1 motif member 13). Decreased ADAMTS13 activity
leads to an accumulation of ultralarge von Willebrand factor (vWF) multimers which induce
aggregation of platelets and microthrombi. These microthrombi may involve the brain, heart,
kidneys and lead to life-threatening organ failures.
In experimental models, magnesium sulfate increases cleavage of newly released vWF by
ADAMTS13, decreases the endothelial secretion of ultralarge vWF and inhibits the interaction
of vWF with platelets. In another thrombotic microangiopathy, magnesium sulfate has been
shown to reduce the risk of seizures in women with severe pre-eclampsia. In analogy with its
evidence-based therapeutic application in pre-eclampsia and based on a strong rationale for
magnesium supplementation in TTP, we propose a phase 3, double blind, placebo controlled, and
randomized study to evaluate the efficacy of magnesium sulfate in more rapidly restoring
normal platelet counts as measure of prevention of further microvascular thrombosis in
patients with Thrombotic Thrombocytopenic Purpura.