ReviewCureus2026
N-acetylcysteine in Thrombotic Thrombocytopenic Purpura: A Systematic Review.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy characterized by severe ADAMTS13 deficiency and accumulation of ultralarge von Willebrand factor multimers. Although therapeutic plasma exchange (PEX), corticosteroids, rituximab, and caplacizumab have improved outcomes, refractory and relapsing disease remain important clinical challenges. N-acetylcysteine (NAC) has been explored as an adjunctive therapy because of its ability to reduce disulfide bonds within von Willebrand factor multimers.
objectiveThis systematic review aimed to summarize the published clinical experience with NAC in TTP, including treatment strategies, reported outcomes, and safety.
methodsA systematic search of PubMed was performed from database inception until December 31, 2025, using combinations of the terms "thrombotic thrombocytopenic purpura", "TTP", "N-acetylcysteine", and "acetylcysteine". Two reviewers independently screened records, assessed full texts against predefined eligibility criteria, and extracted study-level data. Eligible studies included case reports and case series describing therapeutic NAC use in patients with TTP. The review was conducted in accordance with PRISMA 2020 guidance. The protocol was not prospectively registered.
resultsSix publications comprising 22 adult patients were included. NAC was used as adjunctive therapy, predominantly in refractory or relapsing TTP, alongside PEX, corticosteroids, rituximab, and/or other immunosuppressive therapies. Platelet recovery was reported following NAC initiation in the included cases, with concurrent improvement in hemolysis markers and neurologic symptoms described in some reports. No serious NAC-related adverse events were reported in the included cases. Because all evidence was derived from uncontrolled reports with concomitant therapies, the independent contribution of NAC cannot be established.
conclusionsThe available case-based literature suggests that NAC is a biologically plausible and generally well-tolerated adjunctive therapy in refractory or relapsing TTP. However, the current evidence remains hypothesis-generating and is insufficient to establish efficacy. Prospective studies are needed to clarify its therapeutic role, optimal dosing, and patient selection.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.