Thrombotic thrombocytopenic purpura associated with ticlopidine. A review of 60 cases

Ann Intern Med. 1998 Apr 1;128(7):541-4. doi: 10.7326/0003-4819-128-7-199804010-00004.


Background: Thrombotic thrombocytopenic purpura, a life-threatening multisystem disease, has been infrequently associated with use of ticlopidine, a platelet anti-aggregating agent.

Purpose: To review 60 cases of ticlopidine-associated thrombotic thrombocytopenic purpura.

Data sources: Medical records, published case reports, and case reports submitted to the U.S. Food and Drug Administration.

Study selection: Instances of ticlopidine-associated thrombotic thrombocytopenic purpura were identified.

Data synthesis: Ticlopidine had been prescribed for less than 1 month in 80% of the patients, and normal platelet counts had been found within 2 weeks of the onset of thrombotic thrombocytopenic purpura in most patients. Mortality rates were higher among patients who were not treated with plasmapheresis than among those who underwent plasmapheresis (50% compared with 24%; P < 0.05).

Conclusions: Ticlopidine use may be associated with the development of thrombotic thrombocytopenic purpura, usually within 1 month of initiation of therapy. The onset of ticlopidine-associated thrombotic thrombocytopenic purpura is difficult to predict, despite close monitoring of platelet counts.

MeSH terms

  • Adult
  • Aged
  • Cerebrovascular Disorders / prevention & control
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plasmapheresis
  • Platelet Aggregation Inhibitors / adverse effects*
  • Platelet Count
  • Purpura, Thrombotic Thrombocytopenic / chemically induced*
  • Purpura, Thrombotic Thrombocytopenic / diagnosis
  • Purpura, Thrombotic Thrombocytopenic / therapy
  • Ticlopidine / adverse effects*
  • Time Factors
  • Treatment Outcome


  • Platelet Aggregation Inhibitors
  • Ticlopidine