Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim Original article Prevalence of the age-related diseases in older patients with acquired thrombotic thrombocytopenic purpura Pasquale Agosti a , Ilaria Mancini a , Francesca Gianniello b , Paolo Bucciarelli b , Andrea Artoni b , Barbara Ferrari b , Silvia Pontiggia b , Silvia Maria Trisolini c , Luca Facchini d , Cecilia Carbone e , Flora Peyvandi a,b,⁎ , Italian Group of TTP Investigators a Department of Pathophysiology and Transplantation, Università degli Studi di Milano,Via Pace 9, Milan, 20122, Italy b Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy c Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy d Hematology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy e UO Ematologia, ASST Spedali Civili di Brescia, Brescia, Italy ARTICLE INFO Keywords: Elderly Acquired TTP Multimorbidity Polypharmacy Age-related diseases ABSTRACT Background: The prevalence of older patients with acquired thrombotic thrombocytopenic purpura (TTP) is increasing. There is scarce information on the prevalence of multimorbidity, polypharmacy and age-related diseases in aging TTP patients. This study aimed to evaluate the prevalence of multimorbidity and polypharmacy in a population of acquired TTP patients aged 65 years or more compared with a group of age-matched controls. Methods: Acquired TTP patients enrolled in the Milan TTP registry from December 1st 1999 to March 31th 2018 and aged 65 years or more at the date of last follow-up were evaluated. Controls were Italian healthy individuals recruited from 2006 to March 31th 2018 among friends and non-consanguineous relatives of patients tested for thrombophilia screening at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center of Milan. Results: 36 TTP patients and 127 age-matched controls were included. Compared with controls, TTP patients had a higher prevalence of multimorbidity and polypharmacy. They also showed a higher prevalence of autoimmune diseases, osteoporosis and arterial hypertension and were more chronically treated with corticosteroids and antiplatelets for primary cardiovascular prevention. All these results were confirmed after adjusting for sex. Compared with the general elderly population, TTP patients showed a higher prevalence of ischemic heart disease and stroke. Conclusions: Our findings suggest that a careful comprehensive geriatric assessment of acquired TTP patients is necessary. It is important to look for other autoimmune diseases and such age-related comorbidities as osteo- porosis, arterial hypertension, ischemic heart disease and cerebrovascular disease. 1. Introduction The prevalence of older patients with acquired thrombotic throm- bocytopenic purpura (TTP) has increased as a consequence of sig- nificant improvements in disease diagnosis and drug availability. Patient aging may be challenging for the traditional disease manage- ment, which may be affected by the concomitant presence of different age-related diseases and polypharmacy. The growing prevalence of concomitant chronic disease in acquired TTP patients is not only an age-related effect, because a positive history of one or more TTP episodes may increase the risk of developing other diseases, so that a continuous and long-term follow-up of these patients is recommended after clinical remission. In particular, acquired TTP patients often re- port persistent problems dealing with memory, attention and en- durance and have a higher risk of anxiety, depression and worse quality of life [1,2,3]. In a cohort of acquired TTP patients, during a long-term observation after recovery from the first episode, an increased pre- valence of hypertension and major depression was observed [4]. In other studies, [1,5,6] a higher prevalence of mild cognitive impairment was also reported. Two main explanations were proposed. The ischemia https://doi.org/10.1016/j.ejim.2020.01.024 Received 6 November 2019; Received in revised form 27 January 2020; Accepted 29 January 2020 Abbreviations: TTP, thrombotic thrombocytopenic purpura; IQR, interquartile range; CI, confidence interval A complete list of the members of the Italian Group of TTP Investigators appears in the “Study Group Members” in the Supplementary file. ⁎ Corresponding author. Tel.: +39 02 5503 5414, Fax: +39 02 54 100 125. E-mail address: flora.peyvandi@unimi.it (F. Peyvandi). European Journal of Internal Medicine 75 (2020) 79–83 Available online 20 March 2020 0953-6205/ © 2020 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine. T