Clopidogrel‐Induced Thrombotic Thrombocytopenic Purpura–Hemolytic Uremic Syndrome After Coronary Artery Stenting

Abstract

The antiplatelet drug clopidogrel has largely replaced ticlopidine, due to an association between ticlopidine and thrombotic thrombocytopenic purpura–hemolytic uremic syndrome (TTP-HUS). Clopidogrel at first was thought to be void of this potentially fatal adverse effect, but recent case reports have called that assumption into question. Even with proper treatment (plasma exchange), TTP-HUS can persist for weeks. Clinicians should be aware of this possible adverse effect because prompt therapy is imperative for patients' survival. Earlier reports of clopidogrel-related TTP-HUS have involved patients who had received at least 72 hours of therapy. We describe a case of TTP-HUS in a patient who had received only a 300-mg loading dose of clopidogrel.

SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio‐oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista)

“…Baseline TP increases the risk of bleeding and other adverse cardiac events . Acquired TP develops frequently in cancer patients and appears to be different from the TP that occurs after the administration of glycoprotein (GP) IIb/IIIa inhibitors, heparin, thrombolytic therapy, and oral antiplatelet medications, which is strongly associated with ischemic and hemorrhagic complications as well as early mortality .…”

Drug-Induced Nephrotoxicity and Its Biomarkers

“…Antiplatelet agents including cyclosporin, mitomycin-C and quinine have been shown to cause thrombotic microangiopathy (Pisoni et al ., 2001; Manor et al ., 2004).…”

Drug-Induced Thrombotic Microangiopathy

“…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.…”