Abstract Number: PB0876
Meeting: ISTH 2021 Congress
Background: Drug-induced thrombotic microangiopathies (DITMAs) have been associated with thienopyridine antiplatelets such as ticlopidine, discontinued in many markets for this reason, as well as clopidogrel. Clinical use of the thienopyridine prasugrel, and the non-thienopyridines ticagrelor and cangrelor, has increased and it is unclear whether they confer a risk for TMAs.
Aims: To establish if there is a relationship between contemporary P2Y12 receptor antagonists and TMAs.
Methods: We searched MEDLINE, Embase, and Scopus systematically from inception to November 30, 2020 for reports presenting patients receiving P2Y12 receptor antagonists for any indication who developed TMA after exposure. We included only English-language case reports and series, and other primary observational patient-level data. Two reviewers independently screened articles at title/abstract and full-text levels. The primary outcome was the causality likelihood judged by the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment scale. Secondary clinical outcomes such as mortality, use of plasma exchange, and medication restart were determined. Risk of bias was assessed using appropriate validated scales.
Results: A total of 45 unique cases of P2Y12 receptor antagonist-associated TMAs were described in 33 reports between 2000–2020. The implicated agent was clopidogrel in 41 (91%), ticagrelor in 2 (4%), both clopidogrel and ticagrelor in 1 (2%), and prasugrel in 1 (2%). No cases involved cangrelor. WHO-UMC causality ratings were “Probable/likely” in 35 (78%), “Possible” in 7 (16%), “Unlikely” in 1 (2%), and “Unassessable/Unclassifiable” in 2 (4%). Plasma exchange was started in 40 (89%) cases, 6 (13%) died, and a P2Y12 receptor inhibitor was restarted in 6 (13%). Whether restart occurred was unspecified in 2 (4%) cases.
Conclusions: Clopidogrel, ticagrelor, and prasugrel are all potential rare causes of TMA. Most cases responded to withdrawal of the agent and plasma exchange. More exploration of this issue, using population-based data, is indicated.
To cite this abstract in AMA style:C Ho J, Eshaghpour A, Ge S, Foote R, Crowther M. P2Y12 Receptor Antagonists and Drug-induced Thrombotic Microangiopathies: A Systematic Review of the Primary Evidence [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/p2y12-receptor-antagonists-and-drug-induced-thrombotic-microangiopathies-a-systematic-review-of-the-primary-evidence/. Accessed August 9, 2022.
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