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Semin Thromb Hemost 2012; 38(08): 845-853
DOI: 10.1055/s-0032-1328894
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ticlopidine-, Clopidogrel-, and Prasugrel-Associated Thrombotic Thrombocytopenic Purpura: A 20-Year Review from the Southern Network on Adverse Reactions (SONAR)

Sony Jacob
1   South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions (SONAR), South Carolina College of Pharmacy, South Carolina
2   WJB Dorn VA Medical Center, Columbia, South Carolina
,
Brianne L. Dunn
1   South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions (SONAR), South Carolina College of Pharmacy, South Carolina
2   WJB Dorn VA Medical Center, Columbia, South Carolina
,
Zaina P. Qureshi
1   South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions (SONAR), South Carolina College of Pharmacy, South Carolina
,
Nicholas Bandarenko
3   Duke University Medical Center, Durham, North Carolina
,
Hau C. Kwaan
4   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Dilip K. Pandey
5   University of Illinois Medical Center at Chicago, Chicago, Illinois
,
June M. McKoy
4   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Sara E. Barnato
4   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Jeffrey L. Winters
6   Mayo Clinic, Rochester Minnesota
,
John F. Cursio
7   Rush University Medical Center, Chicago, Illinois
,
Ivy Weiss
4   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Thomas J. Raife
8   University of Iowa, Iowa City, Iowa
,
Patricia M. Carey
9   Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
,
Ravindra Sarode
10   University of Texas Southwestern, Dallas, Texas
,
Joseph E. Kiss
11   The Institute for Transfusion Medicine and the University of Pittsburgh, Pittsburgh, Pennsylvania
,
Constance Danielson
12   Indiana University School of Medicine, Indianapolis, Indiana
,
Thomas L. Ortel
3   Duke University Medical Center, Durham, North Carolina
,
William F. Clark
13   London Health Sciences Centre, London, Ontario, Canada
,
Gail Rock
14   Canadian Apheresis Group, Ottawa, Ontario, Canada
,
Masanori Matsumoto
15   Department of Blood Transfusion Medicine, Nara Medical University, Nara, Japan
,
Yoshihiro Fujimura
15   Department of Blood Transfusion Medicine, Nara Medical University, Nara, Japan
,
X. Long Zheng
16   Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Hao Chen
17   eHealthMe, Madison, Wisconsin
,
Fei Chen
17   eHealthMe, Madison, Wisconsin
,
John M. Armstrong
18   Lead Horse Technologies, Junction City, Kansas
,
Dennis W. Raisch
19   College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
,
Charles L. Bennett
1   South Carolina Center of Economic Excellence for Medication Safety and Efficacy and the Southern Network on Adverse Reactions (SONAR), South Carolina College of Pharmacy, South Carolina
2   WJB Dorn VA Medical Center, Columbia, South Carolina
20   Arnold School of Public Health of the University of South Carolina, Columbia, South Carolina
21   Hollings Cancer Center of the Medical University of South Carolina, Charleston, South Carolina
› Author Affiliations
Further Information

Publication History

Publication Date:
30 October 2012 (online)

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Abstract

Thienopyridine-derivatives (ticlopidine, clopidogrel, and prasugrel) are the primary antiplatelet agents. Thrombotic thrombocytopenic purpura (TTP) is a rare drug-associated syndrome, with the thienopyridines being the most common drugs implicated in this syndrome. We reviewed 20 years of information on clinical, epidemiologic, and laboratory findings for thienopyridine-associated TTP. Four, 11, and 11 cases of thienopyridine-associated TTP were reported in the first year of marketing of ticlopidine (1989), clopidogrel (1998), and prasugrel (2010), respectively. As of 2011, the FDA received reports of 97 ticlopidine-, 197 clopidogrel-, and 14 prasugrel-associated TTP cases. Severe deficiency of ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) was present in 80% and antibodies to 100% of these TTP patients on ticlopidine, 0% of the patients with clopidogrel-associated TTP (p < 0.05), and an unknown percentage of patients with prasugrel-associated TTP. TTP is associated with use of each of the three thienopyridines, although the mechanistic pathways may differ.

Keywords

thrombotic thrombocytopenic purpura - ticlopidine - clopidogrel - prasugrel - adverse event
 

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