Abstract
One case of progressive thrombotic thrombocytopenic purpura (TTP) after ticlopidine therapy is reported. A 55-year-old woman was started on ticlopidine therapy for transient ischemic attack. Three weeks after commencing the therapy, the patient was hospitalized because of a relapse of right hemiparesis and dysarthria. Three days after admission, her platelet count was 1.4 × 104, and the peripheral blood film showed a little red cell fragmentation. The prothrombin time, activated partial thromboplastin time, fibrinogen, and FDP levels were normal. On the following day, she suffered vomiting and abdominal pain. The patient became apathetic and drowsy. Six days after admission, generalized convulsions attaclked the patient, and she was transferted to an intensive care unit. Laboratory testing revealed : hemoglobin, 7.4 g/dl; plate count, less than 1.0 × 104; and serum creatinine, 1.6 mg/dl. The peripheral blood film revealed abundant red cell fragmentation. A diagnosis of TTP was confirmed on the basis of thrombocytopenia, fever, renal failure, the neurologic symptoms and microangiopathic hemolytic anemia. Treatment was initiated by plasma infusion with plasma exchange, but the patient died. This is the first case of thrombotic thrombocytopenic purpura (TTP) probably related to the use of ticlopidine in Japan.
