Subacute coronary stent thrombosis in a patient developing clopidogrel associated thrombotic thrombocytopenic purpura

Area of Science:

• Cardiology
• Pharmacology
• Hematology

Background:

• Clopidogrel and aspirin are standard for preventing stent thrombosis after coronary artery procedures.
• Thrombotic thrombocytopenic purpura (TTP) is a rare but serious complication associated with clopidogrel use.

Observation:

• A 78-year-old male with unstable angina underwent coronary stent implantation.
• The patient experienced recurrent stent thrombosis four days post-procedure.
• Fourteen days after initiating clopidogrel, the patient developed thrombocytopenia and petechial purpura, indicative of TTP.

Findings:

• The patient's symptoms and laboratory findings were consistent with clopidogrel-associated TTP.
• Therapeutic plasma exchange led to a prompt clinical response.
• These events suggest clopidogrel may enhance platelet activation and aggregation in susceptible individuals, contributing to stent thrombosis.

Implications:

• This case highlights the importance of considering clopidogrel-induced TTP in patients with stent thrombosis and thrombocytopenia.
• Prompt diagnosis and treatment with plasma exchange are critical for favorable outcomes.
• Further research into the immunological mechanisms of clopidogrel-associated TTP is warranted.