THROMBOTIC THROMBOCYTOPENIC PURPURA ASSOCIATED WITH TICLOPIDINE - A REVIEW OF 60 CASES

Background: Thrombotic thrombocytopenic purpura, a life-threatening mu ltisystem disease, has been infrequently associated with use of ticlop idine, a platelet antiaggregating agent. Purpose: To review 60 cases o f ticlopidine-associated thrombotic thrombocytopenic purpura. Data Sou rces: Medical records, published case reports, and case reports submit ted to the U.S. Food and Drug Administration. Study Selection: Instanc es of ticlopidine-associated thrombotic thrombocytopenic purpura were identified. Data Synthesis: Ticlopidine had been prescribed for less t han 1 month in 80% of the patients, and normal platelet counts had bee n found within 2 weeks of the onset of thrombotic thrombocytopenic pur pura in most patients. Mortality rates were higher among patients who were not treated with plasmapheresis than amog those who underwent pla smapheresis (50% compared with 24%; P<0.05). Conclusions: Ticlopidine use may be associated with the development of thrombotic thrombocytope nic purpura, usually within 1 month of initiation of therapy. The onse t of ticlopidine-associated thrombotic thrombocytopenic purpura is dif ficult to predict, despite close monitoring of platelet counts.