THROMBOTIC THROMBOCYTOPENIC PURPURA ASSOCIATED WITH TICLOPIDINE

OBJECTIVE: To report a case of possible ticlopidine-induced thrombotic thrombocytopenic purpura (TTP). CASE SUMMARY: A 68-year-old man was started on ticlopidine therapy for transient ischemic attack because of aspirin intolerance. Three weeks after starting therapy, the patient developed TTP, manifest by severe thrombocytopenia, renal failure, microangiopathic hemolytic anemia, and neurologic symptoms. The condition reversed over three to five days coincident with the discontinuation of ticlopidine and therapy with daily plasma infusion and exchange. No evidence of relapse was found at one-year follow-up. DISCUSSION: TTP is a well-defined clinical entity with varied etiologies. Ticlopidine has been reported as causing neutropenia and isolated thrombocytopenia. Case reports have linked ticlopidine to the development of TTP. CONCLUSIONS: Including this case there are now seven patients who have been documented as developing TTP while receiving ticlopidine. In addition to monitoring for neutropenia and isolated thrombocytopenia, patients receiving ticlopidine also should be monitored for the development of TTP.