Treatment of Thrombotic Thrombocytopenic Purpura With Antiplatelet Drugs

Thrombotic thrombocytopenic purpura (TTP) is a disease with an extremely high mortality rate. Many modalities of therapy have been tried with very limited success. Lately, antiplatelet drugs have been proposed in the treatment of TTP. We report a well-documented case of TTP that presented with severe hemolytic anemia, thrombocytopenia, neurologic manifestations, kidney involvement, and fever. The patient did not respond to splenectomy, corticosteroids, and heparin sodium, but she made a full recovery after antiplatelet drugs (aspirin and dipyridamole) were added to the therapeutic regimen. The coagulation studies showed thrombocytopenia, hypofibrinogenemia, and a positive protamine sulfate test, indicative of disseminated intravascular clotting. The spleen showed numerous arterioles occluded with subendothelial hyaline material. The platelet investigations during antiplatelet therapy revealed impaired platelet aggregation and clot retraction that became normal after discontinuance of the drugs. The patient has now been in full remission more than 12 mo.