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(Circulation. 2000;101:e9036.)
© 2000 American Heart Association, Inc.

Cardiovascular News

Ruth SoRelle, MPH, Circulation Newswriter

Clopidogrel-Associated Thrombotic Thrombocytopenic Purpura Identified

The drug clopidogrel has been associated with 11 cases of thrombotic thrombocytopenic purpura, a finding that has prompted physicians to warn their peers about the risk to patients. The study, which is scheduled to appear in the June 15 issue of the New England Journal of Medicine, was posted early on the journal’s website (www.nejm.org) because of its clinical implications, a rare waiving of the Ingelfinger Rule against early publication (Thrombotic thrombocytopenic purpura associated with clopidogrel. N Engl J Med. 2000).

"The view was that it was a very benign drug," said Marc Feldman, MD, a coauthor of the story and an associate professor of medicine at the University of Texas Medical School at San Antonio. "This is not a benign drug, and physicians shouldn’t put patients on it and forget about it." He said the finding did not mean that physicians should stop prescribing clopidogrel because the drug is an important therapeutic tool. Nor do the study’s authors want patients to stop taking the drug. "The risk of having an acute myocardial infarction by stopping far outweighs the risk of thrombotic thrombocytopenia purpura" said Dr Feldman.

The finding is of interest because, since it received Food and Drug Administration approval in late 1997, clopidogrel has become more popular for use than a similar drug, ticlopidine, which was also associated with development of thrombotic thrombocytopenic purpura. However, in 20 000 patients in phase 3 clinical trials of clopidogrel, no incidences of this complication were reported. In contrast, the incidence . . . [Full Text of this Article]