Wang Xiaoya, Zhang Shufang, Li Leiqing, Hua Junjie, Zhu Lei, Li Libin, Zhang Gensheng
Department of Cardiology Department of Critical Care Medicine Department of Clinical Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2018 Jun;97(26):e11206. doi: 10.1097/MD.0000000000011206.
Ticagrelor, a new type of P2Y12 receptor antagonist, has been highly recommended to be used in acute coronary syndrome by the latest guideline, but its side effects are not well-known. We seek to illustrate a potential fatal condition, thrombotic thrombocytopenic purpura (TTP), caused by ticagrelor.
An 87-year-old man who had been prescribed with ticagrelor for 2 months after ST-elevation myocardial infarction (STEMI), presented with severe thrombocytopenia, anemia, renal and liver dysfunction, heart failure and fever.
Peripheral blood smear showed schistocytosis, and a disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS13) activity is low, with normal initial coagulation tests, which were compatible with a diagnosis of TTP.
After cessation of ticagrelor and initiation of therapeutic plasma exchange, our patient recovered.
Re-administration of ticagrelor aggravated TTP and led the patient to death.
Clinicians should be aware of the possibility of ticagrelor-induced TTP in patients with a history of recent myocardial infarction; It is of crucial significance to discontinue and never reuse ticagrelor as long as it is suspected to be implicated in TTP.
替格瑞洛是一种新型的P2Y12受体拮抗剂，最新指南强烈推荐其用于急性冠状动脉综合征，但它的副作用尚不清楚。我们试图阐述一种由替格瑞洛引起的潜在致命疾病——血栓性血小板减少性紫癜（TTP）。
一名87岁男性，在ST段抬高型心肌梗死（STEMI）后服用替格瑞洛2个月，出现严重血小板减少、贫血、肝肾功能不全、心力衰竭和发热。
外周血涂片显示破碎红细胞，具有血小板反应蛋白基序的去整合素和金属蛋白酶13（ADAMTS13）活性降低，初始凝血检查正常，符合TTP诊断。
停用替格瑞洛并开始治疗性血浆置换后，患者康复。
重新使用替格瑞洛使TTP加重，导致患者死亡。
临床医生应意识到近期有心肌梗死病史的患者使用替格瑞洛可能诱发TTP；一旦怀疑替格瑞洛与TTP有关，停用并永远不再使用替格瑞洛至关重要。
