Ticlopidine-, clopidogrel-, and prasugrel-associated thrombotic thrombocytopenic purpura: a 20-year review from the Southern Network on Adverse Reactions (SONAR).

Journal Article (Journal Article;Review)

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.

Full Text

Duke Authors

Cited Authors

  • Jacob, S; Dunn, BL; Qureshi, ZP; Bandarenko, N; Kwaan, HC; Pandey, DK; McKoy, JM; Barnato, SE; Winters, JL; Cursio, JF; Weiss, I; Raife, TJ; Carey, PM; Sarode, R; Kiss, JE; Danielson, C; Ortel, TL; Clark, WF; Rock, G; Matsumoto, M; Fujimura, Y; Zheng, XL; Chen, H; Chen, F; Armstrong, JM; Raisch, DW; Bennett, CL

Published Date

  • November 2012

Published In

Volume / Issue

  • 38 / 8

Start / End Page

  • 845 - 853

PubMed ID

  • 23111862

Pubmed Central ID

  • PMC3804561

Electronic International Standard Serial Number (EISSN)

  • 1098-9064

Digital Object Identifier (DOI)

  • 10.1055/s-0032-1328894


  • eng

Conference Location

  • United States