Drugs associated with thrombotic microangiopathy
| Drug . | Possible pathogenesis and treatment . |
|---|---|
| Ticlodopine | Specific to ticlodopine and not other thienopyridine derivatives Association with ADAMTS13 antibodies and respond to PEX |
| Estrogen-containing drugs, eg, COCP | Precipitation of congenital TTP Association with immune TTP cases |
| Quinine | Antibodies against platelets, leukocytes, erythrocytes, and endothelial cells, leading to damage to endothelial cells Question role of PEX |
| Gemcitabine | Dose-dependent endothelial damage, affecting primarily the glomerular arterioles and capillaries Response recorded to eculizumab |
| Mitomycin C | Delayed onset, dose-dependent toxicity, and cumulative Microthrombi affect glomerular capillaries and arterioles Cumulative dose results in irreversible renal damage and no response to PEX |
| VEGF inhibitors, eg, bevacizumab and aflibercept | TMA features limited to the glomerular structures differentiate anti-VEGF-induced thrombotic microangiopathy from other drug causes Supportive care and drug discontinuation |
| Proteosome inhibitors, eg, carfilzomib and bortezomib | Occurs at a median of 3 weeks following medication initiation Favorable response to stopping therapy |
| Thyrosine kinase inhibitors, eg, carfilzomib and bortezomib | Small molecule inhibition of the VEGF receptor Supportive care and drug discontinuation |
| Interferon-β | Direct dose-dependent effect causing endothelial hyperplasia, luminal occlusion, and microaneurysm formation Very delayed (years after initiation) Variable recovery |
| Calcineurin inhibitors, eg, ciclosporin and tacrolimus | Primarily affect glomerular arterioles Reducing the dose/stopping the drug can improve/reverse the TMA |
| Platinum-based drugs, eg, oxaliplatin | Anemia and thrombocytopenia could result from oxaliplatin-dependent antibodies against erythrocytes and platelets |
| Emicizumab (in conjunction with bypassing agents) | Unknown, question excess thrombin resulting in endothelial damage Stop drug, symptomatic symptom control PEX used Drug has been reintroduced on resolution |
| Drug . | Possible pathogenesis and treatment . |
|---|---|
| Ticlodopine | Specific to ticlodopine and not other thienopyridine derivatives Association with ADAMTS13 antibodies and respond to PEX |
| Estrogen-containing drugs, eg, COCP | Precipitation of congenital TTP Association with immune TTP cases |
| Quinine | Antibodies against platelets, leukocytes, erythrocytes, and endothelial cells, leading to damage to endothelial cells Question role of PEX |
| Gemcitabine | Dose-dependent endothelial damage, affecting primarily the glomerular arterioles and capillaries Response recorded to eculizumab |
| Mitomycin C | Delayed onset, dose-dependent toxicity, and cumulative Microthrombi affect glomerular capillaries and arterioles Cumulative dose results in irreversible renal damage and no response to PEX |
| VEGF inhibitors, eg, bevacizumab and aflibercept | TMA features limited to the glomerular structures differentiate anti-VEGF-induced thrombotic microangiopathy from other drug causes Supportive care and drug discontinuation |
| Proteosome inhibitors, eg, carfilzomib and bortezomib | Occurs at a median of 3 weeks following medication initiation Favorable response to stopping therapy |
| Thyrosine kinase inhibitors, eg, carfilzomib and bortezomib | Small molecule inhibition of the VEGF receptor Supportive care and drug discontinuation |
| Interferon-β | Direct dose-dependent effect causing endothelial hyperplasia, luminal occlusion, and microaneurysm formation Very delayed (years after initiation) Variable recovery |
| Calcineurin inhibitors, eg, ciclosporin and tacrolimus | Primarily affect glomerular arterioles Reducing the dose/stopping the drug can improve/reverse the TMA |
| Platinum-based drugs, eg, oxaliplatin | Anemia and thrombocytopenia could result from oxaliplatin-dependent antibodies against erythrocytes and platelets |
| Emicizumab (in conjunction with bypassing agents) | Unknown, question excess thrombin resulting in endothelial damage Stop drug, symptomatic symptom control PEX used Drug has been reintroduced on resolution |
Included are some of the more common drugs documented in association with causing TMA. Most are associated with acute kidney injury and usually present with severe hypertension.