Table 5.

Drugs with evidence supporting a causal association with thrombotic microangiopathy^a

Immune-Mediated TMA	Direct Drug-Induced Toxicity	Other
Quinine: Drug-dependent antibodies	Immunosuppressive agents, e.g., calcineurin inhibitors: ciclosporin and tacrolimus Sirolimus IFN-α, IFN-β	Ticlopidine: ADAMTS13 autoantibodyb
	VEGF inhibitors, e g., bevacizumab, sunitinib
	Chemotherapeutic agents, e.g., gemcitabine, mitomycin
	Recreational drugs, e.g., cocaine

Even if drug-mediated TMA is suspected, a full evaluation should still be undertaken as shown in Figure 3, including an urgent ADAMTS13 assay. TMA, thrombotic microangiopathy; VEGF, vascular endothelial growth factor; TTP, thrombotic thrombocytopenic purpura; ADAMTS13, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13.

^aTMA has been reported in association with many drugs, but definite causality has been established in relatively few (2,88,90,91), some examples of which are included in this table.

^bTiclopidine association with TTP reported, with severe ADAMTS13 deficiency due to inhibitory autoantibodies. This should be managed as for TTP, with plasma exchange (46,92).