Clopidogrel-Associated Neutropenia: Case Report and Review of the Literature
Journal
American Journal of Therapeutics
Journal Volume
23
Journal Issue
5
Pages
e1197-e1201
Date Issued
2016
Author(s)
Abstract
Clopidogrel is a second generation of thienopyridine, which has antiplatelet effect by inhibiting P2Y 12 receptor. Hematologic adverse effect is very uncommon during clopidogrel use, but some cases of clopidogrel-associated neutropenia were reported in the past decade. Until now, there was no summary data to delineate the clinical course and safe alternatives of this event. We report 2 cases of clopidogrel-associated neutropenia and review other 10 case reports from 2000 to 2014. The median onset of neutropenia was 22 days, and the recovery time was 4 days after receiving granulocyte-colony-stimulating factor. Bone marrow studies in 6 cases all showed hypocellular or toxic damage. Six cases used cilostazol, prasugrel, or ticagrelor as safe alternatives. Closely monitoring blood cell counts is highly suggested in the first month after using clopidogrel. Newer P2Y 12 inhibitors, especially ticagrelor, could be effective and safe alternatives if patients had a history of clopidogrel-associated neutropenia. Copyright ? 2015 Wolters Kluwer Health, Inc. All rights reserved.
Subjects
adverse drug event; clopidogrel; neutropenia
SDGs
Other Subjects
acetylsalicylic acid; cefepime; cilostazol; clopidogrel; granulocyte colony stimulating factor; hemoglobin; metronidazole; thallium; ticagrelor; antithrombocytic agent; clopidogrel; granulocyte colony stimulating factor; purinergic P2Y receptor antagonist; ticlopidine; abdominal discomfort; aged; appetite disorder; blood culture; cardiogenic shock; case report; chest tightness; coronary artery disease; coughing; drug dose increase; drug eluting stent; drug substitution; drug withdrawal; dyspnea; female; fever; hemoglobin blood level; human; left anterior descending coronary artery; leukocyte count; loading drug dose; malaise; male; neutropenia; neutrophil count; pancytopenia; percutaneous coronary intervention; priority journal; Pseudomonas aeruginosa; Pseudomonas infection; Review; rhinorrhea; right coronary artery; stent thrombosis; thrombosis prevention; very elderly; weakness; analogs and derivatives; chemically induced; neutropenia; time factor; Aged; Aged, 80 and over; Female; Granulocyte Colony-Stimulating Factor; Humans; Male; Neutropenia; Platelet Aggregation Inhibitors; Purinergic P2Y Receptor Antagonists; Ticlopidine; Time Factors
Type
review