Use of ticlopidine and cilostazol after intracoronary drug-eluting stent placement in a patient with previous clopidogrel-induced thrombotic thrombocytopenic purpura: a case report.

Thrombotic thrombocytopenic purpura (TTP) is an extremely rare but potentially fatal adverse reaction to the thienopyridines, clopidogrel and ticlopidine. We report the case of a patient with a history of clopidogrel-induced TTP who subsequently was successfully treated with aspirin, ticlopidine and cilostazol after stenting for severe, symptomatic coronary artery disease. This case supports the theory that clopidogrel and ticlopidine mediate TTP through slightly different mechanisms and that ticlopidine may be safely used in this setting if absolutely necessary. Moreover, while sufficient data are lacking, the combination of aspirin and cilostazol in this setting may provide adequate antithrombotic protection long term after drug-eluting stent placement.