Download PDF
J Neurol Surg Rep 2015; 76(02): e287-e290
DOI: 10.1055/s-0035-1566127
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Clopidogrel-Associated Thrombotic Thrombocytopenic Purpura following Endovascular Treatment of Spontaneous Carotid Artery Dissection

Jerry A. Rubano
1   Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York, United States
,
Kwan Chen
2   Stony Brook University School of Medicine, Stony Brook, New York, United States
,
Brianne Sullivan
2   Stony Brook University School of Medicine, Stony Brook, New York, United States
,
James A. Vosswinkel
1   Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York, United States
,
Randeep S. Jawa
1   Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York, United States
› Author Affiliations
Further Information

Publication History

25 June 2015

19 August 2015

Publication Date:
25 October 2015 (online)

   Permissions and Reprints

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disease secondary to platelet aggregation. We present a patient who developed profound thrombocytopenia and anemia 8 days following initiation of therapy with clopidogrel after stent placement for carotid artery dissection. She did not have a disintegrin and metalloproteinase with thrombospondin domain 13 (ADAMTS 13) deficiency. Management included steroids and therapeutic plasma exchange. Clopidogrel has rarely been associated with TTP. Unlike other causes of acquired TTP, the diagnosis of early clopidogrel-associated TTP is largely clinical given the infrequent reduction in ADAMTS 13 activity.

Keywords

clopidogrel - TTP - carotid - stent - thrombocytopenia
 

  • References

  • 1 Rose M, Rowe JM, Eldor A. The changing course of thrombotic thrombocytopenic purpura and modern therapy. Blood Rev 1993; 7 (2) 94-103
    CrossrefPubMedGoogle Scholar
  • 2 George J, Leung L, Timauer J. Diagnosis of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome in adults. Available at: http://www.uptodate.com.proxy.library.stonybrook.edu/contents/diagnosis-of-thrombotic-thrombocytopenic-purpura-hemolytic-uremic-syndrome-in-adults?source=search_result&search=ttp+diagnosis&selectedTitle=1~150 . Accessed May 27, 2015
    PubMedGoogle Scholar
  • 3 Scully M, Hunt BJ, Benjamin S , et al; British Committee for Standards in Haematology. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol 2012; 158 (3) 323-335
    CrossrefPubMedGoogle Scholar
  • 4 Bennett CL, Connors JM, Carwile JM , et al. Thrombotic thrombocytopenic purpura associated with clopidogrel. N Engl J Med 2000; 342 (24) 1773-1777
    CrossrefPubMedGoogle Scholar
  • 5 Verbij FC, Fijnheer R, Voorberg J, Sorvillo N. Acquired TTP: ADAMTS13 meets the immune system. Blood Rev 2014; 28 (6) 227-234
    CrossrefPubMedGoogle Scholar
  • 6 Zakarija A, Kwaan HC, Moake JL , et al. Ticlopidine- and clopidogrel-associated thrombotic thrombocytopenic purpura (TTP): review of clinical, laboratory, epidemiological, and pharmacovigilance findings (1989–2008). Kidney Int Suppl 2009; (112) S20-S24
    PubMedGoogle Scholar
  • 7 Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK ; Society for Vascular Surgery. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg 2011; 54 (3) e1-e31
    CrossrefPubMedGoogle Scholar
  • 8 Liapis CD, Bell PR, Mikhailidis D , et al; ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 2009; 37 (4, Suppl): 1-19
    PubMedGoogle Scholar
  • 9 Bell B, Layland J, Poon K, Spaulding C, Walters D. Focused clinical review: periprocedural management of antiplatelet therapy in patients with coronary stents. Heart Lung Circ 2011; 20 (7) 438-445
    CrossrefPubMedGoogle Scholar
  • 10 Jacob S, Dunn BL, Qureshi ZP , et al. Ticlopidine-, clopidogrel-, and prasugrel-associated thrombotic thrombocytopenic purpura: a 20-year review from the Southern Network on Adverse Reactions (SONAR). Semin Thromb Hemost 2012; 38 (8) 845-853
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Bennett CL, Kim B, Zakarija A , et al; SERF-TTP Research Group. Two mechanistic pathways for thienopyridine-associated thrombotic thrombocytopenic purpura: a report from the SERF-TTP Research Group and the RADAR Project. J Am Coll Cardiol 2007; 50 (12) 1138-1143
    CrossrefPubMedGoogle Scholar
  • 12 Matetzky S, Fefer P, Shenkman B, Varon D, Savion N, Hod H. Effectiveness of reloading to overcome clopidogrel nonresponsiveness in patients with acute myocardial infarction. Am J Cardiol 2008; 102 (5) 524-529
    CrossrefPubMedGoogle Scholar
  • 13 Tan LA, Keigher KM, Munich SA, Moftakhar R, Lopes DK. Thromboembolic complications with Pipeline Embolization Device placement: impact of procedure time, number of stents and pre-procedure P2Y12 reaction unit (PRU) value. J Neurointerv Surg 2015; 7 (3) 217-221
    CrossrefPubMedGoogle Scholar
  • 14 Price MJ, Angiolillo DJ, Teirstein PS , et al. Platelet reactivity and cardiovascular outcomes after percutaneous coronary intervention: a time-dependent analysis of the Gauging Responsiveness with a VerifyNow P2Y12 assay: Impact on Thrombosis and Safety (GRAVITAS) trial. Circulation 2011; 124 (10) 1132-1137
    CrossrefPubMedGoogle Scholar