Copyright 1999 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: As authors of the first article
on the incidence of ticlopidine hydrochloride–associated thrombotic
thrombocytopenic purpura (TTP) after coronary artery stenting,1
we would like to comment on the follow-up article on this subject by Dr Steinhubl
and colleagues.2 Our incidence data indicated
a frequency that is 3-fold as frequent as reported in their article (1 in
1600 vs 1 in 4800).1,3 Moreover,
as both Steinhubl et al and we have stated, case-finding by surveying interventional
cardiologists is likely to underestimate the true frequency of this adverse
effect. None of the cardiologists involved in the cases that we reposed was
aware that TTP had occurred in their patients. Although we agree that limiting
therapy to 2 weeks after stenting does not prevent the development of TTP,
the occurrence of this syndrome is rare. Of the 61 known cases of ticlopidine-associated
TTP in patients who received coronary artery stenting, only 5 occurred in
less than 2 weeks of therapy; of those, none has died (Table 1).
Bennett CL, Davidson CJ, Green D, Weinberg PD, Feldman MD. Ticlopidine and TTP After Coronary Stenting. JAMA. 1999;282(18):1717–1719. doi:10.1001/jama.282.18.1717
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