Ticlopidine is an oral antiplatelet agent frequently utilized in the treatment of cere brovascular disease. It is rarely associated with severe bone marrow suppression. A case of an elderly woman is reported who developed febrile agranulocytosis two months after commencing ticlopidine but who had a favorable outcome after cessation of that drug and treatment with granulocyte colony-stimulating factor (G-CSF). All patients should have regular monitoring of their blood counts during therapy with ticlopidine.
Get full access to this article
View all access options for this article.
References
1.
Young NS: Agranulocytosis. JAMA271:935-938, 1994.
2.
Keeling RP: Non-neoplastic disorders of granulocytes and monocytes. In: Fundamentals of Clinical Hematology, ed. 5, ed. by Thorup OA.Philadelphia : WB Saunders, 1987 , pp 424-459.
3.
Hass WK, Easton JD, Adams HP, et al: A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high risk patients. N Engl J Med321:501-507, 1989.
4.
Schoming A., Neumann FJ, Kastrati A., et al: A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary artery stents. N Engl J Med334:1084-1089, 1996.
5.
Lesesve JF, Callat MP, Lenormand B., et al: Hematological toxicity of ticlopidine. Am J Hematol47:149-150,1994.
Marinella MA : Reversible hyperkalemia associated with trimethoprim-sulfamethoxazole . Am J Med Sci310:115-117, 1995.
8.
Marquez JA, Pardo C., Amutio E., et al: Drug-induced agranulocytosis: Clinical study of 19 cases. Sangre43:436-438, 1998.
9.
Garnier G., Taillan B., Pesce A., et al: Ticlopidine and severe aplastic anemia. Br J Haematol81:459-460, 1992.
10.
Guerciolini R., Giordano G., Aversa F., et al: Anaemia and agranulocytosis associated with ticlopidine therapy. Acta Haematol73:232-234, 1985.
11.
Bedani PL, Fiocchi O., Scapoli PL, et al: Leukopenia due to ticlopidine in a patient with chronic renal failure. Haematologica69:641-642, 1984.
12.
Mataix R., Ojeda E., Perez Mdc, et al: Ticlopidine and severe aplastic anemia. Br J Haematol80:125-126, 1992.
13.
Troussard X. , Mayo P., Mosquet B., et al: Ticlopidine and severe aplastic anemia . Br J Haematol82:779-780, 1992.
14.
Khelif A., Assouline D., Ffrench M., et al: Ticlopidine and severe aplastic anemia. Br J Haematol83:678-679, 1993.
15.
Haushofer A. , Halbmayer WM, Pracher H.: Neutropenia with ticlopidine plus aspirin . Lancet349:474-475, 1987.
16.
Ono K., Kurohara K., Yoshihara M., et al: Agranulocytosis caused by ticlopidine and its mechanism. Am J Hematol37:239-242, 1991.
17.
Quaglino D. , Salladini G., Ricciotti M.: Possible mechanism of action of ticlopidine on committed granulocyte macrophage precursors. Haematologica69:257-262, 1984.
18.
Martin-Nunez G., Fdez-Soria RR, Sanchez-Gil F., et al: Aplastic anemia and ticlopidine. Br J Haematol85:633, 1993.
19.
Korkmaz ME, Cekin AH: Bone marrow suppression and Klebsiella pneumonia septicemia due to ticlopidine and successful treatment with filgrastim: A case report. Int J Cardiol66:317-318, 1998.
20.
Szto GY, Linnemeier TJ, Ball MW: Fatal neutropenia and thrombocytopenia associated with ticlopidine after stenting . Am J Cardiol83:138-139, 1999.