Drug-induced thrombotic microangiopathy.
Drug-associated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (TTP/HUS) has been recognized for several years. The most commonly implicated drugs are mitomycin-C, cyclosporine, quinine, and ticlopidine. As with idiopathic cases of TTP/HUS, basic science discoveries in the late 1990s now suggest that the likely mechanisms by which these agents lead to a thrombotic microangiopathy (TMA) include either an immune-mediated phenomenon involving the ADAMTS13 metalloprotease or direct endothelial toxicity. This article reviews the current understanding of the pathogenesis, the clinical and laboratory features, and the recommended treatments, prognosis, and outcomes of drug-associated TMA.
Zakarija
Anaadriana
A
Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Bennett
Charles
C
D051722:ADAM Proteins / Q000276:immunology; D000071120:ADAMTS13 Protein; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects / Q000276:immunology; D016572:Cyclosporine / Q000009:adverse effects / Q000276:immunology; D004730:Endothelium, Vascular / Q000276:immunology / Q000293:injuries / Q000473:pathology; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000276:immunology; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced / Q000276:immunology / Q000473:pathology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000276:immunology; D016685:Mitomycin / Q000009:adverse effects / Q000276:immunology; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced / Q000276:immunology / Q000473:pathology / Q000628:therapy; D011803:Quinine / Q000009:adverse effects / Q000276:immunology; D013988:Ticlopidine / Q000009:adverse effects / Q000276:immunology; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D005343:Fibrinolytic Agents; D007166:Immunosuppressive Agents; D016685:Mitomycin; D016572:Cyclosporine; D011803:Quinine; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human; D013988:Ticlopidine