Ticlopidine-associated pancytopenia: implications of an acetylsalicylic acid alternative.
Ticlopidine is an antiplatelet agent that has been proven efficacious in preventing vascular events in patients with a history of vasculopathy. Neutropenia is a significant adverse effect and pancytopenia is rarely reported. A fatal case of pancytopenia associated with unmonitored use of ticlopidine is presented. A 59-year-old woman presented with severe pneumonia and profound neutropenia (absolute neutrophil count 0%). She deteriorated with development of acute respiratory distress syndrome and a marked reduction in trilineage hematopoiesis. Despite prompt marrow response to granulocyte macrophage colony-stimulating factor (GM-CSF) and cessation of ticlopidine, appropriate antibiotics and other supportive therapy, she died 17 days after admission. Hematological monitoring is imperative to identify potential complications: if discovered late, there may be a role for GM-CSF for marrow support. Ticlopidine is indicated for patients intolerant of or nonresponsive to acetylsalicylic acid therapy. As the use of ticlopidine increases, clinicians must be aware of potential life-threatening complications associated with its use and monitor appropriately.
Gill
S
S
Department of Medicine, University of Alberta, Edmonton.
Majumdar
S
S
Brown
N E
NE
Armstrong
P W
PW
D001241:Aspirin / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D004351:Drug Resistance; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D010198:Pancytopenia / Q000139:chemically induced*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000473:pathology; D013988:Ticlopidine / Q000009:adverse effects*
D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D001241:Aspirin