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Ticlopidine-Associated Thrombotic Thrombocytopenic Purpura
- Kenneth J. Mukamal, MD;
- Barry Wu, MD; and
- Peter McPhedran, MD
- Beth Israel Deaconess Medical Center; Boston, MA 02215 Yale University School of Medicine; New Haven, CT 06520
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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.
Kenneth J. Mukamal, MD
Beth Israel Deaconess Medical Center; Boston, MA 02215
Barry Wu, MD
Peter McPhedran, MD
Yale University School of Medicine; New Haven, CT 06520
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
