ticagrelor and Purpura--Thrombotic-Thrombocytopenic

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.

Topics: ADAMTS13 Protein; Adenosine; Aged, 80 and over; Fatal Outcome; Humans; Male; Plasma Exchange; Purinergic P2Y Receptor Antagonists; Purpura, Thrombotic Thrombocytopenic; ST Elevation Myocardial Infarction; Ticagrelor; Withholding Treatment

BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is associated with widespread microvascular thrombosis, low platelet count, and hemolysis. Ticagrelor is a relatively new agent which functions as a reversible inhibitor of the P2Y12 receptor working to prevent platelet aggregation and is used with or without aspirin in patients with acute coronary syndrome to reduce the risk of myocardial infarction and stroke. We describe the case of an 80-year-old man with ischemic heart disease who developed this rare and potentially fatal adverse reaction known as TTP following treatment with ticagrelor. CASE REPORT We report the case of an 80-year-old man who presented with an acute change in mental status 4 months after initiating ticagrelor following percutaneous coronary intervention. Laboratory testing on presentation revealed evidence of microangiopathic hemolytic anemia, thrombocytopenia, and elevated creatinine levels, suggestive of acute renal failure. The combination of his clinical symptoms and laboratory findings were concerning for TTP, likely secondary to ticagrelor use. The patient was treated with therapeutic plasma exchange, systemic steroids, and hemodialysis, which led to resolution of the hemolysis and recovery of renal function. CONCLUSIONS Although the association between ticagrelor and TTP is rare, early recognition of this life-threatening complication is essential to decrease morbidity and mortality associated with TTP. Since ticagrelor is now more commonly used, it is important that clinicians be aware of this complication.

Topics: Acute Coronary Syndrome; Aged, 80 and over; Hemolysis; Humans; Male; Plasma Exchange; Purpura, Thrombotic Thrombocytopenic; Ticagrelor

Topics: ADAM Proteins; Humans; Purpura, Thrombotic Thrombocytopenic; Recurrence; Ticagrelor

Topics: Adult; Chest Pain; Coronary Angiography; Diagnosis, Differential; Drug-Eluting Stents; Humans; Male; Myocardial Infarction; Platelet Aggregation Inhibitors; Purpura, Thrombotic Thrombocytopenic; Ticagrelor