Severe Bone Marrow Suppression Associated with Use of Clopidogrel

Zacharia, George Sarin; Randhawa, Mandeep Singh; Marino, N; Spaccavento, Colette

doi:10.15744/2348-9820.4.401

Cited by 1 publication

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“…Indeed, the clinical utility of the latter has been limited by this adverse effect [11]. Clinically overt marrow suppression with clopidogrel is much less common and severe leukopenia is rare but nevertheless cases of associated thrombocytopenia, leukopenia or pancytopenia have been reported and attributed to non-P2Y 12 -mediated myelotoxic effects of clopidogrel metabolites in susceptible individuals [12][13][14][15]. Here, the WBC reduction seen with clopidogrel was not driven by higher rates of severe leukopenia.…”

Section: Discussionmentioning

confidence: 84%

Differential effect of clopidogrel and ticagrelor on leukocyte count in relation to patient characteristics, biomarkers and genotype: a PLATO substudy

et al. 2021

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Inflammation plays a key role in cardiovascular disease by contributing to atherothrombosis. The PLATelet inhibition and patient Outcomes (PLATO) study (NCT00391872) compared ticagrelor to clopidogrel in patients with acute coronary syndromes and demonstrated fewer cardiovascular events with ticagrelor but lower white blood cell counts (WBC) with clopidogrel. In this further analysis of the PLATO biomarker substudy, we assessed associations between WBC and clinical characteristics, biomarker levels, and CYP2C19 polymorphisms. On-treatment mean (SD) WBC in the clopidogrel group was mildly reduced at each stage of follow-up compared with either the ticagrelor group (1 month: 7.27 (2.1) and 7.67 (2.23) x10 9 /L for clopidogrel and ticagrelor, respectively; p < .001) or following cessation of clopidogrel (7.23 (1.97) x10 9 /L, at 6 months vs 7.56 (2.28) x10 9 /L after treatment cessation; P < .001). This occurred independently of baseline biomarkers and CYP2C19 genotype (where known). Adjusting for clinical characteristics and other biomarkers, no significant interaction was detected between clinical risk factors and the observed effect of clopidogrel on WBC. Clopidogrel weakly suppresses WBC, independent of clinical characteristics, baseline inflammatory biomarker levels, and CYP2C19 genotype. Further work is required to determine the mechanism for this effect and whether it contributes to clopidogrel's efficacy as well as therapeutic interaction with anti-inflammatory drugs. History

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