When starting clopidogrel therapy, which complication should be monitored for?

Clopidogrel therapy is associated with the risk of thrombotic thrombocytopenic purpura (TTP), a rare but serious complication characterized by a pentad of symptoms: microangiopathic hemolytic anemia, thrombocytopenic purpura, neurological symptoms, renal dysfunction, and fever. This condition occurs due to the inhibition of von Willebrand factor-cleaving protease, leading to the accumulation of large von Willebrand factor multimers and subsequent microthrombi formation that can cause damage to various organs.

Monitoring for TTP is critical when initiating clopidogrel, especially in individuals who may be at an increased risk, as early recognition and treatment are essential to improve outcomes. While other complications may be associated with various conditions or medications, TTP is notably linked to the use of clopidogrel, making it the key concern when starting this therapy.

Other conditions like hemorrhagic stroke, acute kidney injury, or liver failure may arise in different contexts or due to other medications, but they are not specifically linked to clopidogrel in the same direct way as TTP. Therefore, focusing on TTP allows healthcare providers to effectively monitor and intervene in a timely manner should symptoms arise during clopidog