P2Y12 inhibition after thrombotic thrombocytopenic purpura remission

We read the article entitled “Ticagrelor-associated thrombotic thrombocytopenic purpura” by Doğan et al. (1), which was recently published in the Anatolian Journal of Cardiology, with great interest. It is well known that patients with acute coronary syndrome (ACS) who visit the emergency department have increased rates of recurrent ischemic events. Dual antiplatelet therapy (DAPT) is of importance to reduce these rates; further, DAPT duration after drug-eluting stent (DES) implantation is one the most significant determinant for reducing recurrent ischemic events, including stent thrombosis (2). In your case, DAPT was discontinued 5 weeks after ACS because of ticagrelor-associated thrombotic thrombocytopenic purpura (TTP), and aspirin was used as the only antiplatelet therapy for 6 months. According to the guidelines, DAPT should be administered for at least 12 months after ACS is treated with DES implantation (2). Further, retreatment with P2Y12 after TTP complete remission in ACS can be considered necessary. Reportedly, it is possible to encounter rechallenge with the same P2Y12 inhibitors, leading to TTP after remission. It was indicated that this approach does not induce relapse (3). I