Thrombotic thrombocytopenia purpura

The most frequent side effects of clopidogrel are nausea, vomiting, and diarrhea (5% of patients). Thrombotic thrombocytopenia purpura has been reported rarely. The most serious side effect of clopidogrel is hemorrhage. 

Thrombotic thrombocytopenic purpura (TTP) is a severe systemic disorder characterized by the thrombi formation within the circulation that result in the platelet consumption and subsequent thrombocytopenia. The inherited sub-type is chronic and relapsing and generally occurs in childhood. Acute idiopathic TTP, which occurs in adults, is more common and harder to treat. The estimated annual incidence of TTP is 3.7 cases per million.33... 

Acyclovir 200 mg PO q4hour x 7-/0 days 400 mg PO 3 times daily x 7-10 days3 200 mg PO q12hour x 7-1 0 days6 Headache, confusion, nausea, vomiting, thrombocytopenia, renal insufficiency, rash, pruritus, fever, arthralgias, myalgia, thrombotic thrombocytopenic purpura, hallucinations, somnolence, depression... 

Another type of autoantibody leading to thrombocytopenia that is induced by ti-clopidine is directed against von Willebrand factor metalloproteinase [45 ]. This prevents the normal clearance of large multimers of von Willebrand this can lead to platelet aggregation, and in some cases, to thrombotic thrombocytopenic purpura, commonly referred to as TTP. Many other drugs have been implicated as cases of TTP, but the mechanism is unclear and appears to differ with different drugs [46],... 

In addition to the risk of bleeding, which will be detailed in the different studies, thienopyridines are able to cause skin disorders (rashes or prurit) and gastrointestinal disorders (diarrhea). In the CLASSICS study, these side effects were observed in 8.2% of patients treated with ticlopidine and in 3.5% of those taking clopidogrel treatment. The most serious problem was related to hematologic disorders neutropenia or thrombocytopenia. These disorders are much less frequent with clopidogrel than with ticlopidine 0.04% of neutropenia in the CAPRIE study and 0.05% in the CURE trial, Thrombotic thrombocytopenic purpura are exceptional one for 200,000 patients. 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

Hematologic Anemia, aplastic anemia, neutropenia, thrombocytopenia, thrombotic thrombocytopenic purpura... 

Fatal ciprofloxacin-associated thrombotic thrombocytopenic purpura (28) and thrombocytopenia (29) have been reported. 

There have been several cases of thrombotic thrombocytopenic purpura or Moschcowitz s syndrome, characterized by intravascular coagulation, thrombocytopenia, and hemolysis, as a rare but life-threatening comphcation of penicillamine (153-156). There is one case report of Evans syndrome, thrombocytopenic purpura in combination with autoimmune hemolytic anemia, in suspected association with penicillamine (157). In this patient antiplatelet antibodies as well as antibodies against erythrocytes were detected. 

Various other hematological complications have been observed during ticlopidine treatment (5). They include neutropenia, agranulocytosis, thrombocytopenia, aplastic anemia, pancytopenia, and thrombotic thrombocytopenic purpura (6). These reactions are potentially severe and some are fatal. Major bleeding is rare. Among 188 cases of hematological comphcations associated with ticlopidine and reported to the US Food and Drug Administration, 36 (19%) resulted in death (7). 

Several therapeutic agents can promote the development of Thrombotic Micro Angiopathy (TM A), which is characterized clinically by microangiopathic hemolytic anemia, thrombocytopenia, and various ischemic end organ manifestations. Pathologically, vessel wall thickening, endothehal cell swelling, intraluminal platelet thrombi, and microvascular occlusion are noted [158]. Some forms of TMA are dominated by renal impairment and are usually referred to as haemolytic uremic syndrome (HUS) others show predominant central nervous system involvement and are referred to as thrombotic thrombocytopenic purpura (TTP). 

VolcyJ,NzerueCM,OderindeA, Hewan-LoweK. Cocaine-induced acute renal failure, hemolysis, and thrombocytopenia mimick-ing thrombotic thrombocytopenic purpura. Am J Kidney Dis 2000 35 E3. 

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