[Cholestatic hepatitis as a rare side effect of therapy with ticlopidine].
A 71-year-old man with chronic atrial fibrillation was treated with aspirin because of a right cerebral infarction. Oral anticoagulation was not initiated because of a secondary hemorrhagic transformation. Six years later after a left cerebral transient ischemic attack aspirin was replaced by ticlopidine. Two weeks after starting ticlopidine he experienced abdominal cramps and diarrhea. Also dark urine and gray-colored stools were noticed, so that the patient stopped taking ticlopidine. 40 days after starting ticlopidine he was admitted to our hospital because of cholestatic jaundice. Serum alkaline phosphatase (305 U/l) and gamma GT (143 U/l) were elevated, the total bilirubin was 18.6 mg/dl at peak. GOT and GPT were 2.7 fold increased. After exclusion of a viral infection and autoimmune disease liver biopsy was performed, which showed a centroacinar cholestasis compatible with a drug-induced liver damage. 79 days after discontinuation of the drug laboratory signs of cholestasis had disappeared. In patients in whom long-term therapy with ticlopidine is indicated regularly laboratory tests and clinical examinations should be done to recognize infrequent side effects such as the cholestatic hepatitis in time.
Berent
R
R
I. Interne Abteilung, Gastroenterologie, Allgemein Offentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, Wels, Osterreich.
Hinterholzer
G
G
Höbling
W
W
Auer
J
J
Haidenthaler
A
A
Knoflach
P
P
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D001707:Biopsy, Needle; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002779:Cholestasis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D002908:Chronic Disease; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000188:drug therapy; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D013988:Ticlopidine / Q000009:adverse effects*
D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine