Thrombotic Thrombocytopenic Purpura Associated with Clopidogrel
| Autor: | Marc D. Feldman, Stefano R. Tarantolo, Joel L. Moake, William R. Bell, Amy J. Hatfield, Charles J. Davidson, Elizabeth L. Michalets, Charles L. Bennett, Jean M. Connors, John M. Carwile, Ravindra Sarode, Leo J. McCarthy, Han-Mou Tsai |
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| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty Ticlopidine Antiplatelet drug Thienopyridine medicine.medical_treatment Thrombotic thrombocytopenic purpura Fatal Outcome Recurrence Internal medicine medicine Humans Platelet cardiovascular diseases Adverse effect Aged Plasma Exchange Purpura Thrombotic Thrombocytopenic business.industry General Medicine Middle Aged medicine.disease Clopidogrel Surgery Clinical trial Female business Platelet Aggregation Inhibitors circulatory and respiratory physiology medicine.drug |
| Zdroj: | New England Journal of Medicine. 342:1773-1777 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejm200006153422402 |
| Popis: | Background The antiplatelet drug clopidogrel is a new thienopyridine derivative whose mechanism of action and chemical structure are similar to those of ticlopidine. The estimated incidence of ticlopidine-associated thrombotic thrombocytopenic purpura is 1 per 1600 to 5000 patients treated, whereas no clopidogrel-associated cases were observed among 20,000 closely monitored patients treated in phase 3 clinical trials and cohort studies. Because of the association between ticlopidine use and thrombotic thrombocytopenic purpura and other adverse effects, clopidogrel has largely replaced ticlopidine in clinical practice. More than 3 million patients have received clopidogrel. We report the clinical and laboratory findings in 11 patients in whom thrombotic thrombocytopenic purpura developed during or soon after treatment with clopidogrel. Methods The 11 patients were identified by active surveillance by the medical directors of blood banks (3 patients), hematologists (6), and the manufacturer of clopidogrel (2). Results Ten of the 11 patients received clopidogrel for 14 days or less before the onset of thrombotic thrombocytopenic purpura. Although 10 of the 11 patients had a response to plasma exchange, 2 required 20 or more exchanges before clinical improvement occurred, and 2 had relapses while not receiving clopidogrel. One patient died despite undergoing plasma exchange soon after diagnosis. Conclusions Thrombotic thrombocytopenic purpura can occur after the initiation of clopidogrel therapy, often within the first two weeks of treatment. Physicians should be aware of the possibility of this syndrome when initiating clopidogrel treatment. |
| Databáze: | OpenAIRE |
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