Ticlopidine-induced aplastic anemia and quick recovery with G-CSF: Case report and literature review

Abstract

We report here a case of ticlopidine-induced aplastic anemia that responded to G-CSF and review the literature. An 83-year-old woman was started on ticlopidine for coronary artery disease after an episode of upper gastrointestinal bleeding secondary to aspirin. She developed aplastic anemia seven weeks after initiation of ticlopidine. She was hos-pitalised and received empiric antibiotic therapy and granulocyte colony stimulating factor (G-CSF). Her bone marrow started to recover quickly, and white blood cell and platelet counts returned to normal within three weeks. A review of medical literature revealed 20 similar cases of ticlopidine-induced aplastic anemia resulting in death in seven cases. G-CSF has been used previously with variable success. Ticlopidine is associated with serious, sometimes fatal hematological side effects. This risk should be seriously taken into consideration when prescribing ticlopidine. G-CSF may be helpful in the treatment of ticlopidine-induced aplastic anemia. Am. J. Hematol. 63:90-93, 2000.

Ticlopidine-Induced Marrow Aplasia Treated with Cyclosporine

“…However, there are articles praising the effectiveness of growth factors (14)(15)(16). Vinod and associates recently reported a rapid and sustained response with cyclosporine and high-dose corticosteroids in a patient with ticlopidine-induced marrow aplasia.…”

Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review

“…Ono et al [ 13 ] suggested ticlopidine exhibited an inhibitory effect on colony-forming unit in culture (CFU-C) directly and dose-dependently. This might be caused by a local increase in prostaglandin E1 produced by ticlopidine or result from an immunologic mechanism [ 14 ]. Maseneni et al [ 15 ] demonstrated thienopyridines’ metabolites formed by myeloperoxidase led to the toxicity on neutrophil granulocytes.…”

Ticlopidine‐induced aplastic anemia: Two new case reports, review, and meta‐analysis of 55 additional cases

“…Only half of the TIAA cases reviewed in this study are provided by a Medline search, because they are either published in journals not indexed by Medline or not characterized as aplastic anemia by their authors. For this reason a similar review published last year has included only 20 cases [69], while up to that time, no fewer than 50 cases were published. In our review we have included cases published in the English, French, Italian, and Spanish literature.…”