Leavey SF, Weinberg J
Thrombotic thrombocytopenic purpura associated with
J Am Soc Nephrol
(Apr) 8:689-693 1997
Ticlopidine is an anti-platelet drug effective in preventing stroke
and myocardial infarction. It has been shown to inhibit ADP-induced
transformation of the platelet glycoprotein IIb/IIIa complex, thus
preventing exposure of binding sites for fibrinogen, von Willebrand
factor, and other adhesive macromolecules. Leavey and Weinberg report
a 52-year-old man who developed thrombotic thrombocytopenic purpura
(TTP) while on ticlopidine therapy. Neurological symptoms, renal
function and hematological parameters improved with discontinuation of
ticlopidine, plasmapharesis with fresh frozen plasma replacement, and
forced alkaline diuresis with mannitol. The authors postulate the
mechanism of ticlopidine induced TTP involves the direct effect of the
drug on vascular endothelium.
Comment: In addition to the case report, the authors
discuss eight previously reported cases of ticlopidine induced TTP.
No comorbid conditions or concomitant drugs were associated with
increased risk of developing TTP while on ticlopidine. The manuscript
presents a concise overview of drug induced TTP and comparative data
on the postulated pathogenesis of this syndrome. (George R.
Aronoff, M.D., University of Louisville, Kentucky)