Clopidogrel-induced mixed hepatocellular and cholestatic liver injury

Area of Science:

• Cardiology
• Pharmacology
• Hepatology

Background:

• Clopidogrel is a widely used antiplatelet medication for patients with coronary artery disease, particularly after stent implantation.
• Adjunctive antiplatelet therapy is crucial for preventing stent thrombosis but can be associated with adverse effects.

Observation:

• An 81-year-old female patient developed symptomatic liver disease three weeks after initiating clopidogrel therapy.
• The liver disease onset was temporally linked to the short-term, periprocedural use of clopidogrel following coronary stenting.

Findings:

• This case represents a rare instance of symptomatic liver disease associated with clopidogrel administration in the context of coronary stenting.
• The patient was also receiving other medications metabolized by cytochrome P450 2C9, raising questions about potential drug interactions.

Implications:

• The findings suggest that clopidogrel, even with short-term use, can potentially cause liver injury.
• Further investigation is warranted to understand the clinical significance and mechanisms of clopidogrel-induced liver injury, especially in patients with multiple drug therapies.
• Clinicians should maintain a high index of suspicion for drug-induced liver injury in patients presenting with liver dysfunction after clopidogrel initiation.