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Anti-vWF nanobody (TTP)

Caplacizumab

Brand names: Cablivi

Caplacizumab is an anti-von Willebrand factor humanised single-domain antibody (nanobody) used, alongside plasma exchange and immunosuppression, for acquired thrombotic thrombocytopenic purpura (aTTP).

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It binds the A1 domain of von Willebrand factor, blocking its interaction with platelet glycoprotein Ib and thereby preventing the ultra-large vWF-mediated platelet microthrombi that characterise aTTP.

Prescribing in practice

  • Bleeding is the principal risk; withhold around invasive procedures and have a strategy for managing haemorrhage, as it inhibits vWF-platelet interaction.
  • It is given as an adjunct to plasma exchange and immunosuppression, not as monotherapy for aTTP.
  • Treatment is typically continued for a period after plasma exchange ends, guided by ADAMTS13 activity and response.

Monitoring

Monitor for signs of bleeding, platelet count recovery and ADAMTS13 activity to guide duration of therapy.

Counselling the patient

  • Report any unusual bruising, nosebleeds, gum bleeding or blood in urine or stool promptly.
  • Tell any clinician or dentist you are receiving this medicine before procedures or surgery.
  • An initial dose may be given intravenously with subsequent subcutaneous self-administration after training.

Evidence & guidelines

Efficacy in reducing the time to platelet count normalisation and recurrence was shown in the HERCULES trial, and caplacizumab is recommended by NICE for acquired TTP.

Reference: NICE TA667; BSH TTP guideline; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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