Intravenous prostacyclin in thrombotic thrombocytopenic purpura: case report and review of the literature.
The use of prostacyclin infusion in thrombotic thrombocytopenic purpura is consistent with the hypothesis that patients may lack a plasma factor stimulating prostacyclin production. However, prostacyclin therapy, alone or in combination with aspirin, dipyridamole, steroid and plasmapheresis, failed in many cases. We here describe the case of a patient who responded dramatically to a combination of prostacyclin and plasma infusions, after conventional therapy had failed (plasmapheresis, fresh frozen plasma infusions). Prostacyclin was infused intravenously initially for 120 h from 4 to 9 ng kg min-1 and then continuously for 48 h at 9 ng kg min-1. Despite the scarcity of case reports in the literature, we conclude that the failure of prostacyclin in thrombotic thrombocytopenic purpura appears to be related to insufficient doses and/or duration of therapy.
Tardy
B
B
Department of Emergency Medicine, Hospital de Bellevue, Saint-Etienne, France.
Page
Y
Y
Comtet
C
C
Tardy-Poncet
B
B
Zeni
F
F
Decousus
H
H
Bertrand
J C
JC
D000328:Adult; D001241:Aspirin / Q000627:therapeutic use; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D004176:Dipyridamole / Q000627:therapeutic use; D011464:Epoprostenol / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010949:Plasma; D010956:Plasmapheresis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000188:drug therapy* / Q000628:therapy
D004176:Dipyridamole; D011464:Epoprostenol; D001241:Aspirin; D008775:Methylprednisolone