To report a case of aplastic anemia that developed during ticlopidine treatment.
CASE SUMMARY:
An 84-year-old woman was started on ticlopidine for secondary stroke prevention. Within six weeks of initiating ticlopidine therapy she developed aplastic anemia. She was hospitalized and received empiric antibiotics, antifungal agents, blood transfusions, platelets, and granulocyte colony-stimulating factor. The patient died on day 76 after beginning ticlopidine.
DISCUSSION:
Hematologic effects such as neutropenia, thrombocytopenia, agranulocytosis, thrombotic thrombocytopenic purpura, and pancytopenia have been described with the use of ticlopidine. Previous case reports have associated ticlopidine with the development of aplastic anemia.
CONCLUSIONS:
Ticlopidine can produce fatal hematologic adverse effects, and its use should be reserved as second-line therapy.
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References
1.
De GarmontACanuelCKrulikMBautersFDegosLMartyM, Toxicité hématologique de la ticlopidine?Nouv Rev Fr Hematol1982; 24: 35–7.
2.
GuercioliniRGiordanoGAversaFDel FaveroA. Anaemia and agranulocytosis associated with ticlopidine therapy. Acta Haemat1985; 73: 232–4.
3.
HarbisonJW, The Ticlopidine Aspirin Stroke Study Group. Ticlopidine versus aspirin for the prevention of recurrent stroke. Stroke1992; 23: 1723–7.
4.
GentMEastonJDHachinskiVCPanakESicurellaJBlakelyJA, The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet1989; 1: 1215–20.
5.
HassWKEastonJDAdamsHPPryse-PhillipsWMolonyBAAndersonS, A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med1989; 321: 501–7.
6.
JanzonLBergqvistDBobergJErikssonILingärdeFPerssonG. Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicenter Study. J Intern Med1990; 227: 301–8.
7.
McTavishDFauldsDGoaKL. Ticlopidine: An updated review of its pharmacology and therapeutic uses in platelet-dependent disorders. Drugs1990; 40: 238–59.
8.
KovacsMJSoongPYChin-YeeIH. Thrombotic thrombocytopenic purpura associated with ticlopidine. Ann Pharmacother1993; 27: 1060–1.
9.
AlbersGW. Role of ticlopidine for prevention of stroke. Stroke1992; 23: 912–6.
10.
GarnierGTaillanBPesceAChichmanianRMDujardinP. Ticlopidine and severe aplastic anaemia (letter). Br J Haematol1992; 81: 459–60.
11.
TroussardXMayoPMosquetBRemanOLeporrierM. Ticlopidine and severe aplastic anaemia (letter). Br J Haematol1993; 83: 779–80.
12.
OnoKKuroharaKYoshiharaMShimamotoYYamaguchiM. Agranulocytosis caused by ticlopidine and its mechanism. Am J Hematol1991; 37: 239–42.
13.
ClassFHJDe FraitureWHMeyboomRHB. Thrombopénie causée par des anticorps induits par la ticlopidine. Nouv Rev Fr Hematol1984; 26: 323–4.
14.
QuaglinoDSalladiniGRicciottiM. Possible mechanism of action of ticlopidine on committed granulocyte-macrophage precursor. Haematologica1984; 69: 257–62.
BalmerCM. Clinical use of biologic response modifiers in cancer treatment: An overview. Part II. Colony-stimulating factors and interleukin-2. DICP Ann Pharmacother1991; 25: 490–8.
18.
OrenRPolakAGoldenhershMHeymanANaparstekY. Nifedipine-induced nonthrombocytopenic purpura. DICP Ann Pharmacother1989; 23: 88.
19.
McEvoyGK, ed. American Hospital Formulary Service drug information. Bethesda, MD: American Society of Hospital Pharmacists, 1994: 1385.
HsuVD. Criteria for use of ticlopidine in adult inpatients and outpatients. Clin Pharm1993; 12: 64–6.
22.
Flores-RunkPRaaschRH. Ticlopidine and antiplatelet therapy. Ann Pharmacother1993; 27: 1090–8.
23.
HaynesRBSandlerRSLarsonEBPaterJLYatsuFM. A critical appraisal of ticlopidine, a new antiplatelet agent. Effectiveness and clinical implications for prophylaxis of atherosclerotic events. Arch Intern Med1992; 152: 1376–80.
