Ticlopidine and Thrombotic Thrombocytopenic Purpura

To the Editor: Ticlopidine hydrochloride (Ticlid) is a potent platelet-antiaggregating agent that has been used in the United States since 1991 to reduce the risk of thrombotic stroke in patients with aspirin intolerance. Recently, it has been demonstrated to decrease the incidence of cardiac events and reocclusion after the placement of a coronary-artery stent.1 We report two cases of fulminant thrombotic thrombocytopenic purpura that developed within three weeks of the initiation of ticlopidine therapy after coronary-stent placement. A 47-year-old woman presented in September 1996 with a 48-hour history of increasing confusion, icterus, and nausea. Three weeks before admission she had . . .