Clopidogrel-induced Thrombotic Microangiopathy in a Patient with Hypocomplementemia

Kazuhiro Tada; Kenji Ito; Aki Hamauchi; Koji Takahashi; Renya Watanabe; Ai Uchida; Yasuhiro Abe; Tetsuhiko Yasuno; Katsuhisa Miyake; Yoshie Sasatomi; Hitoshi Nakashima

doi:10.2169/internalmedicine.55.5703

CASE REPORTS

Clopidogrel-induced Thrombotic Microangiopathy in a Patient with Hypocomplementemia

Kazuhiro Tada, Kenji Ito, Aki Hamauchi, Koji Takahashi, Renya Watanabe, Ai Uchida, Yasuhiro Abe, Tetsuhiko Yasuno, Katsuhisa Miyake, Yoshie Sasatomi, Hitoshi Nakashima

Author information

Kazuhiro Tada
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Kenji Ito
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Aki Hamauchi
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Koji Takahashi
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Renya Watanabe
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Ai Uchida
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Yasuhiro Abe
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Tetsuhiko Yasuno
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Katsuhisa Miyake
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Yoshie Sasatomi
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan
Hitoshi Nakashima
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Japan

Keywords: thrombotic microangiopathy, clopidogrel, thrombotic thrombocytopenic purpura, plasma exchange, atypical hemolytic uremic syndrome, alternative pathway

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 8 Pages 969-973

DOI https://doi.org/10.2169/internalmedicine.55.5703

Details

Abstract

Clopidogrel was administered to a 67-year-old Japanese man to prevent the recurrence of cerebral infarction. Twelve weeks later, he was admitted to our hospital with acute renal failure, hemolytic anemia and thrombocytopenia, and was diagnosed with clopidogrel-induced thrombotic microangiopathy. Clopidogrel was immediately discontinued and corticosteroid and plasma exchange therapy were administered simultaneously. Thereafter, the patient's condition gradually improved. The patient had a decreased serum complement C3 level. This suggests that the activated alternative pathway is related to thrombotic microangiopathy (TMA). TMA is a critical drug-associated adverse reaction that clinicians should always be vigilant about, because clopidogrel is widely prescribed.

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