Ishikawa Tatsunori, Makita Masanori, Saeki Kyosuke, Hara Yoshitaka, Yamamoto Kazuhiko, Imajo Kenji
Department of Hematology and Oncology, Okayama City Hospital.
Rinsho Ketsueki. 2012 Jun;53(6):628-31.
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease that is a rare complication of thienopyridine treatment, especially clopidogrel. Here we report a case of clopidogrel-associated TTP. A 77-year-old male initially complained of petechiae on his legs 6 weeks after clopidogrel treatment following coronary artery stenting. He was admitted 4 weeks later with slurred speech and low-grade fever. Laboratory findings showed severe thrombocytopenia, hemolytic anemia with fragmented red cells, renal dysfunction and severe deficiency of ADAMTS13 activity with the presence of the inhibitor. Based on the clinical course and laboratory findings, he was diagnosed with TTP and underwent plasma exchange, followed by improvement of symptoms and laboratory abnormalities after 7 courses of plasma exchange. Nevertheless, the patient died of sepsis due to perforated small intestinal diverticulitis 89 days after admission. Thienopyridine-associated TTP usually occurs within 12 weeks after initiation of the therapy. Physicians should therefore be aware of this fatal complication associated with clopidogrel therapy and frequent blood tests, every 2 weeks during the first 12 weeks, is recommended for early diagnosis.
血栓性血小板减少性紫癜（TTP）是一种危及生命的疾病，是噻吩并吡啶类药物治疗罕见的并发症，尤其是氯吡格雷。在此，我们报告一例氯吡格雷相关性TTP病例。一名77岁男性在冠状动脉支架置入术后接受氯吡格雷治疗6周后，最初抱怨腿部出现瘀点。4周后，他因言语不清和低热入院。实验室检查结果显示严重血小板减少、伴有破碎红细胞的溶血性贫血、肾功能不全以及存在抑制剂时ADAMTS13活性严重缺乏。根据临床病程和实验室检查结果，他被诊断为TTP，并接受了血浆置换，在7次血浆置换疗程后症状和实验室异常情况得到改善。然而，患者在入院89天后因小肠憩室穿孔并发败血症死亡。噻吩并吡啶相关性TTP通常在治疗开始后的12周内发生。因此，医生应意识到这种与氯吡格雷治疗相关的致命并发症，建议在开始治疗的前12周内每2周进行一次血常规检查以早期诊断。
