Clopidogrel-induced thrombotic thrombocytopenia after years of medication

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized by fever,
microangiopathy hemolytic anemia, thrombocytopenia, neurological signs and renal insufficiency. The
real culprit is agglutinated platelets and fibrin which form micro thrombi, gets deposited in arterioles and
capillaries without eliciting inflammatory response. The idiopathic cases of TTP are characterized by deficiency
of ADAMTS-13 (a disintegrin and metalloprotease, with thrombospondin -1 like domains) metalloprotease
activity. The use of antiplatelet drugs, the thienopyridine derivatives Clopidogrel & Ticlodipine, is associated
with drug induced TTP. The literature studies indicate that most cases of thienopyridine associated
TTP involve an antibody to ADAMTS-13 metalloprotease that cause thrombocytopenia and respond to
therapeutic plasma exchange (TPE).We report a case of 59 year old male who was on Clopidogrel post
coronary angioplasty since past five years. He presented to us with complaints of nose bleeding and renal
insufficiency. The evaluation of this potentially fatal drug complication should be borne in mind by physicians
for all patients receiving Clopidogrel treatment.