Ticagrelor-associated thrombotic thrombocytopenic purpura

Doğan, Ali; Özdemir, Behzat; Bal, Hamit; Özdemir, Emrah; Kurtoğlu, Nuri

doi:10.14744/anatoljcardiol.2017.7426

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…One case of ticagrelor-induced TTP has been reported very recently. [ 3 ] However, the causal association of ticagrelor with TTP in that case was not definite according to the criteria established for drug-induced thrombotic microangiopathy. [ 4 , 5 ] Thus we presented here an interesting and relatively confirmed case of TTP, which presented with acute heart failure besides other classic findings of TTP, occurred after administration of ticagrelor for as long as 2 months, and recurred rapidly and incurably with reuse of ticagrelor.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 , 5 ] Drugs used in our patient, which have been reported to cause TTP, were clopidogrel [ 17 ] and ticagrelor. [ 3 ] The recent prescription of clopidorel was from 10th to 14th June 2017, which was more than 2 months before onset of TTP. However, according to the published data, the onset of TTP following administration of clopidogrel was < 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only one case of ticagrelor-induced TTP has been diagnosed clinically and reported. [ 3 ] Herein, we provided a relatively confirmed case of ticagrelor-induced TTP, which occurred in a patient with ST-elevation myocardial infarction (STEMI) after taking ticagrelor for 2 months. Although the patient recovered with prompt treatment of plasma exchange afterwards, re-administration of ticagrelor led to a fatal consequence.…”

Section: Introductionmentioning

confidence: 99%

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Ticagrelor-induced thrombotic thrombocytopenic purpura

Wang

Zhang²,

Li³

et al. 2018

Medicine

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Rationale:Ticagrelor, a new type of P2Y12 receptor antagonist, has been highly recommended to be used in acute coronary syndrome by the latest guideline, but its side effects are not well-known. We seek to illustrate a potential fatal condition, thrombotic thrombocytopenic purpura (TTP), caused by ticagrelor.Patient concerns:An 87-year-old man who had been prescribed with ticagrelor for 2 months after ST-elevation myocardial infarction (STEMI), presented with severe thrombocytopenia, anemia, renal and liver dysfunction, heart failure and fever.Diagnoses:Peripheral blood smear showed schistocytosis, and a disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS13) activity is low, with normal initial coagulation tests, which were compatible with a diagnosis of TTP.Interventions:After cessation of ticagrelor and initiation of therapeutic plasma exchange, our patient recovered.Outcomes:Re-administration of ticagrelor aggravated TTP and led the patient to death.Lessons:Clinicians should be aware of the possibility of ticagrelor-induced TTP in patients with a history of recent myocardial infarction; It is of crucial significance to discontinue and never reuse ticagrelor as long as it is suspected to be implicated in TTP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ticagrelor-induced thrombotic thrombocytopenic purpura

Wang

Zhang²,

Li³

et al. 2018

Medicine

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“…Pemberian steroid bisa sebagai terapi pelengkap dan dilanjutkan selama 2 bulan. 16,17 Oleh karena itu, penghentian pemberian ticaglerol merupakan pilihan yang tepat pada pasien ini. Namun, dengan dihentikannya pemberian ticaglerol juga berisiko terhadap peningkatan kejadian thrombosis pada pasien ini.…”

Section: No 3 2018unclassified

Perdarahan saluran cerna setelah dilakukan intervensi koroner perkutan: suatu keputusan terapi yang sulit

Putra¹,

Fadil

Ilhami

2018

Maj Kedokt Andalas

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Intervensi koroner perkutan merupakan prosedur invasif jantung yang sering dilakukan untuk mengobati pasien dengan penyakit arteri koroner. Komplikasi yang menakutkan seperti diseksi koroner atau penyumbatan koroner akut pada era balon angioplasti telah banyak berkurang dengan ditemukannya stent arteri koroner dan penggunaan rutin terapi antiplatelet dan antitrombotik. Peningkatan penggunaan DAPT tersebut meningkatkan risiko pasien untuk terjadinya cedera saluran cerna dan perdarahan. Mengobati pasien yang mengalami perdarahan setelah IKP merupakan suatu hal yang rumit, karena kita harus mempertimbangkan intervensi yang tepat untuk mengelola perdarahan aktif, untuk menimbang manfaat potensial untuk meneruskan atau menghentikan terapi antiplatelet dan untuk mengevaluasi apakah diperlukan transfusi sel darah merah yang bisa menimbulkan efek samping yang merugikan. Pemberian PPI direkomendasikan oleh panduan Amerika dan Eropa untuk terapi yang bisa diberikan pada perdarahan saluran cerna akibat pemberian antiplatelet dan hemostasis endoskopi merupakan pilihan yang direkomendasikan untuk mengurangi angka morbiditas dan mortalitas.

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“…We read the article entitled “Ticagrelor-associated thrombotic thrombocytopenic purpura” by Doğan et al ( 1 ), which was recently published in the Anatolian Journal of Cardiology, with great interest. It is well known that patients with acute coronary syndrome (ACS) who visit the emergency department have increased rates of recurrent ischemic events.…”

mentioning

confidence: 99%