Guard against drug
Thrombotic thrombocytopenic purpura (TTP) is due to diffuse microvascular thrombosis caused by a rare obstruction, the clinical syndrome mortality rate is very high. TTP clinical manifestations of thrombocytopenia, hemolytic anemia, neuropsychiatric symptoms, fever and kidney failure five Fallot. As a result of systemic platelet aggregation platelet count dropped to 20 × 109 per liter, is often less, such as untreated or not treated early mortality rate of 90%.
Some drugs in the course of the pharmacological effects because of the special, may lead to TTP, the use of these drugs require special attention during the patient's blood as the change to avoid serious consequences.
Main causative drugs Antiplatelet clinical observation balloon coronary stenting (PTCA) in patients with TTP in the incidence rate of 0.02%, while the general population the incidence rate of 0.004%, due to PTCA patients receiving anti-platelet drugs widely used. Studies have shown that lower doses of anti-platelet drugs, shortening treatment do not seem to prevent the occurrence of TTP.
Increasingly widespread application as clopidogrel, ticlopidine significantly replace the trend. Clopidogrel induced TTP previously that the incidence of lower than ticlopidine, but more and more clinical studies confirm that patients with coronary stent implantation were treated with clopidogrel induced thrombosis incidence and mortality, regardless of TTP TTP incidence and severity is the incidence of clopidogrel than ticlopidine, ticlopidine and clopidogrel drug 14 TTP incidence of 9.7% and 74.3% before treatment,> 14 days the incidence of were 90.3% and 25.7%. Description ticlopidine clopidogrel induced TTP longer than the incubation period; ticlopidine induced severe thrombocytopenia (<20 × 109 per liter) the incidence (60.0%) than clopidogrel (83.9%); addition the application within 14 days of clopidogrel occurred TTP to plasma exchange therapy (PE) and the absence of PE in the survival rates were 70.0% and 66.7%,> 14 days after the occurrence of TTP to the survival rate of 77.8% PE, but also less than ticlopidine. Thus, clopidogrel-induced TTP incidence and mortality rates higher than ticlopidine.
Is worth emphasizing that the TTP caused by ticlopidine clinical outcome and length of incubation period and whether to take PE directly related to the occurrence of TTP within 14 days for PE whether or not, the survival rate is 100%; and> 14 days occurred in TTP, survival time for PE were 84.1%, no PE, the survival rate is only 38.1%.
Immunosuppressant immunosuppressant after organ transplantation is the most common drug-induced causes of TTP. According to 257 cases of lung transplant patient, single center study of tacrolimus immunosuppression caused by a total of 8 cases (incidence 0.03%) thrombotic microangiopathy, worsening anemia, thrombocytopenia, or acute renal failure, with unexplained lactic dehydrogenase (LDH) level increased, decreased haptoglobin. Previously had caused two cases of tacrolimus in lung transplant patients, the report of hemolytic uremic syndrome, use of cyclosporine A after the condition improved.
Anti-inflammatory drugs aspirin is suspected TTP caused by drugs, dipyrone, aminopyrine, phenacetin, U.S. interest rates pseudoephedrine tablets, etc. Cold TTP caused by drugs, also have been reported. Clinicians may sometimes be mistaken for epidemic hemorrhagic fever TTP or hemolytic uremic syndrome (HUS) reported that appears, TTP and HUS are typical of thrombotic microangiopathy, both clinical and pathological often difficult to distinguish, it was tend to TTP / HUS in saying.
Anti-infective anti-infective cause a lot of TTP's report. At present, rifampin, sulfonamides (eg sulfamethoxazole), metronidazole, quinine, ciprofloxacin, chloramphenicol, clarithromycin, Cephalosporin , Penicillins (piperacillin, penicillin, ampicillin), etc., but most are case reports. It is worth noting, metronidazole vaginal gel to use only 1 can also cause TTP.
Influenza Vaccine influenza vaccine induced TTP already scattered reports associated with the suspected cases of influenza vaccine in 2 cases report.
Heparin heparin-induced thrombocytopenia do not have the typical microvascular hemolysis, thrombocytopenia in individual patients and TTP co-exist.
Anticancer drug mitomycin C was the most reported cause TTP of anticancer drugs, gemcitabine has also been reported.
Other drugs, cocaine, procainamide, phenytoin sodium iodide chloroquine, oral contraceptives, estrogen, progesterone and other clinical reports have caused TTP.
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