LETTER
Ticlopidine-Associated Thrombotic Thrombocytopenic Purpura
Kenneth J. Mukamal, MD;
Barry Wu, MD; and
Peter McPhedran, MD
15 November 1998 | Volume 129 Issue 10 | Page 837
TO THE EDITOR:
Bennett and colleagues [1] present a comprehensive review of currently identified cases of thrombotic thrombocytopenic purpura (TTP) associated with use of ticlopidine. Given the high case-fatality rate of TTP and the increasing use of ticlopidine, their description of this possible association is welcome and important. However, as with any case-series, the absence of a denominator (patient-years of exposure) makes assessment of the strength of this association difficult. In addition, as the authors note, an antiplatelet agent such as ticlopidine seems an unlikely culprit to cause a disease characterized by intravascular platelet thrombi. In fact, we have previously presented preliminary data on three patients with severe relapsing TTP whose disease went into sustained remission after treatment with ticlopidine [2]. This therapeutic trial was based on successful previous experience in Italy [3].
Given these seeming contradictions in both mechanism and effect between ticlopidine and TTP, we believe that their association may prove to be more complex than Bennett and colleagues describe.
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Author and Article Information
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Beth Israel Deaconess Medical Center; Boston, MA 02215
Yale University School of Medicine; New Haven, CT 06520
1. Bennett CL, Weinberg PD, Rozenberg-Ben-Dror K, Yarnold PR, Kwaan HC, Green D. Thrombotic thrombocytopenic purpura associated with ticlopidine: a review of 60 cases. Ann Intern Med. 1998; 128:541-4.
2. McPhedran P, Mukamal K. Ticlopidine for relapsing TTP [Abstract]. Blood. 1994; 84(suppl 1):80a.
3. Vianelli N, Catani L, Belmonte MM, Sermasi G, Cascione ML, Gianni L, et al. Ticlopidine in the treatment of thrombotic thrombocytopenic purpura: report of two cases. Haematologica. 1990; 75:274-7.
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