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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.


Xiaoya Wang, Shufang Zhang, Leiqing Li, Junjie Hua, Lei Zhu, Libin Li, Gensheng Zhang. Ticagrelor-induced thrombotic thrombocytopenic purpura: A case report and review of the literature. Medicine. 2018 Jun;97(26):e11206

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PMID: 29952973

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