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Thrombotic Thrombocytopenic Purpura Associated with Ticlopidine: A Review of 60 Cases

Charles L. Bennett, MD, PhD; Peter D. Weinberg, BS; Karine Rozenberg-Ben-Dror, PharmD; Paul R. Yarnold, PhD; Hau C. Kwaan, MD, PhD; and David Green, MD, PhD
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From Northwestern University and Chicago Veterans Affairs HealthCare System-Lakeside Division, Chicago, Illinois. Acknowledgments: The authors thank Drs. Diane Wysowski and Janos Bacsanyi of the U.S. Food and Drug Administration for providing information on retrieval of reports and for review of the manuscript; Drs. Dave Aboulafia, Harvey Einhorn, James Grossman, Robert Hecht, Chitra Raman, Tariq Mahmood, Peter Townley, Michael Voralia, and Walter Kahr, as well as Hal Lieberman, Nurit Begani, and Dr. Josh Levy and the staff of HemaCare Corp., Sherman Oaks, California, for contributing case histories and helpful comments; Dr. James George, for helpful comments; and our index patient, for her assistance and interest. Requests for Reprints: Charles Bennett, MD, PhD, Veterans Affairs Medical Sciences Building, #205, 400 East Ontario, Chicago, IL 60611. Current Author Addresses: Dr. Bennett and Mr. Weinberg: Veterans Affairs Medical Sciences Building, #205, 400 East Ontario, Chicago, IL 60611.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(7):541-544. doi:10.7326/0003-4819-128-7-199804010-00004
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Background: Thrombotic thrombocytopenic purpura, a life-threatening multisystem disease, has been infrequently associated with use of ticlopidine, a platelet anti-aggregating agent.

Purpose: To review 60 cases of ticlopidine-associated thrombotic thrombocytopenic purpura.

Data Sources: Medical records, published case reports, and case reports submitted to the U.S. Food and Drug Administration.

Study Selection: Instances of ticlopidine-associated thrombotic thrombocytopenic purpura were identified.

Data Synthesis: Ticlopidine had been prescribed for less than 1 month in 80% of the patients, and normal platelet counts had been found within 2 weeks of the onset of thrombotic thrombocytopenic purpura in most patients. Mortality rates were higher among patients who were not treated with plasmapheresis than among those who underwent plasmapheresis (50% compared with 24%; P < 0.05).

Conclusions: Ticlopidine use may be associated with the development of thrombotic thrombocytopenic purpura, usually within 1 month of initiation of therapy. The onset of ticlopidine-associated thrombotic thrombocytopenic purpura is difficult to predict, despite close monitoring of platelet counts.





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