Thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome associated with clopidogrel: report of two new cases

Andersohn, Frank; Hagmann, Franz Geert; Garbe, E

doi:10.1136/hrt.2004.039214

Cited by 16 publications

(3 citation statements)

References 7 publications

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“…Despite the lower incidence of TTP with clopidogrel, as its use increases, cases of clopidogrel-associated TTP continue to be recognized by the medical community. 3,73,[80][81][82][83][84][85][86] The first case series of clopidogrel-associated TTP was published in 2000. 80 Of the first 11 cases reported, 10 occurred from 3 to 14 days after initiation of the agent.…”

Section: Thienopyridinesmentioning

confidence: 99%

Drug-Induced Thrombotic Microangiopathy

Zakarija

Bennett

2005

Semin Thromb Hemost

122

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Drug-associated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (TTP/HUS) has been recognized for several years. The most commonly implicated drugs are mitomycin-C, cyclosporine, quinine, and ticlopidine. As with idiopathic cases of TTP/HUS, basic science discoveries in the late 1990s now suggest that the likely mechanisms by which these agents lead to a thrombotic microangiopathy (TMA) include either an immune-mediated phenomenon involving the ADAMTS13 metalloprotease or direct endothelial toxicity. This article reviews the current understanding of the pathogenesis, the clinical and laboratory features, and the recommended treatments, prognosis, and outcomes of drug-associated TMA.

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Section: Thienopyridinesmentioning

confidence: 99%

Drug-Induced Thrombotic Microangiopathy

Zakarija

Bennett

2005

Semin Thromb Hemost

122

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“…Despite the overall favorable safety profile of clopidogrel, physicians should be aware of the possibility of rare adverse effects, such as thrombotic thrombocytopenic purpura (TTP) [133][134][135][136][137][138], haemolytic uremic syndrome [136,137,139,140], bone marrow failure [141][142][143] and acquired haemophilia A [144], occurring within days after the initiation of clopidogrel treatment. Clopidogrelassociated TTP usually occurs within the first two weeks of treatment onset, occasionally relapses and has a high mortality rate unless promptly identified and treated with plasma exchange [145].…”

Section: Safety Profile Of Clopidogrelmentioning

confidence: 99%

Aspirin and Clopidogrel: A Sweeping Combination in Cardiology

Manolis

Tzeis²,

Andrikopoulos³

et al. 2005

CMCCHA

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Platelets play a pivotal role in the pathogenesis of atherothrombosis, believed to be integrally involved in both the development and progression of atherosclerotic heart disease, as well as in its acute thrombotic complications. Antiplatelet therapy constitutes the cornerstone in the management of patients with acute coronary syndromes and generally high-risk patients with atherothrombosis. Until recently, long-term antiplatelet therapy for the treatment and prevention of the complications of atherothrombotic disease was traditionally limited to aspirin. The availability of the thienopyridines, in particular clopidogrel, represents an important addition to the physician's armamentarium. Clopidogrel is currently one of the most widely prescribed drugs for the treatment of symptomatic coronary artery disease. Aspirin and clopidogrel interfere with platelet activation in complementary, but separate pathways. Aspirin irreversibly inhibits cyclooxygenase, thus preventing the production of thromboxane A(2), which is a prothrombotic and vasoconstrictive substance. Clopidogrel, a newer thienopyridine which has largely supplanted ticlopidine due to a more favorable safety profile, irreversibly prevents platelet activation by blocking one of the three known adenosine 5'-diphosphate (ADP) receptors (the P2Y(12) receptor) on the platelet surface, thus interfering with platelet activation, degranulation and aggregation. Both these antiplatelet agents have a potent protective effect against adverse vascular events, but the combination of these two agents has an even stronger antiplatelet effect translating into superior antithrombotic protection in coronary, cerebral or peripheral arterial disease, without an inordinate increase in bleeding complications. A number of seminal clinical trials have demonstrated and confirmed the incremental benefit and efficacy of the combination of clopidogrel and aspirin therapy above and beyond that of aspirin alone, with multiple other important large-scale clinical trials currently ongoing. Newer data are being accumulated from studies where indications for the use of clopidogrel and aspirin continue to expand into other patient groups, rendering this dual antiplatelet drug therapy a sweeping combination in Cardiology. However, important issues remain to be further and more thoroughly explored about the benefit of this antiplatelet drug combination in these other patient groups, such as in patients with heart failure, where preliminary data indicate a favorable effect on thrombotic vascular events, in patients with atrial fibrillation, where there is hope that this combination may replace or be an alternative treatment modality to coumadin in certain subpopulations, in patients undergoing demanding catheter ablation procedures, where data point to a protective effect from thromboembolic events. Another pertaining issue to be further investigated is the occurrence of drug-resistance observed in some patients for both these antithrombotic agents. This article is a comprehensive review of all ...

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“…sensitivity have included cutaneous reactions (eg, urticaria, rash), angioedema, febrile neutropenia, thrombotic thrombocytopenia purpura/hemolytic uremic syndrome, and anaphylaxis with shock. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Although these reactions are considered rare, as the number of patients who require clopidogrel therapy increases, physicians treating these patients may encounter these hypersensitivity reactions more frequently. Therefore, hypersensitivity to clopidogrel can present a serious obstacle to medical treatment in a small but significant group of patients with coronary artery disease (CAD) who have undergone cardiac stent placement.…”

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confidence: 99%