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Fatal neutropenia and thrombocytopenia associated with ticlopidine
1Patient Care Services, Group Health Cooperative of Puget Sound, Seattle, WA 98112.
Objective:
To report the first case of ticlopidine-associated neutropenia resulting in sepsis and death.
Case Summary:
An 83-year-old Filipino man was started on ticlopidine 250 mg bid. By the seventh week of therapy his absolute neutrophil count (ANC) had dropped to 2700 from 7600 x 10(6) cells/L. The ticlopidine was stopped. Six days later, he was admitted to the hospital. He died 18 hours later of gram-negative sepsis.
Discussion:
Although ticlopidine therapy was discontinued four days after the patient's ANC was 2700 x 10(6) cells/L, the ANC dropped to and remained at 0 until his death eight days later. This may be associated with the patient's decreased clearance of ticlopidine given his age and impaired renal function. This is the first reported case of moderate or severe neutropenia in a nonwhite patient and the first reported case of sepsis and death caused by ticlopidine.
Conclusions:
Healthcare professionals must be aware of the possibility of severe neutropenia and death caused by ticlopidine, even when the manufacturers' monitoring guidelines are followed.
Insights
This case report details a fatal instance of ticlopidine-associated neutropenia and sepsis in an elderly Filipino man. It highlights the critical need for vigilance regarding ticlopidine
Area of Science:
- Hematology
- Pharmacology
- Clinical Case Reports
Background:
- Ticlopidine is an antiplatelet medication.
- Neutropenia is a potential adverse effect of ticlopidine therapy.
- Severe neutropenia can lead to life-threatening infections like sepsis.
Observation:
- An 83-year-old Filipino male developed severe neutropenia during ticlopidine treatment.
- Despite discontinuation of ticlopidine, his absolute neutrophil count (ANC) dropped to zero.
- The patient subsequently developed gram-negative sepsis and died.
Findings:
- This is the first reported case of ticlopidine-associated severe neutropenia and sepsis leading to death in a non-white patient.
- The patient's age and impaired renal function may have contributed to decreased ticlopidine clearance and prolonged neutropenia.
- Neutropenia occurred despite adherence to manufacturer's monitoring guidelines.
Implications:
- Healthcare providers must maintain a high index of suspicion for ticlopidine-induced neutropenia, even with standard monitoring.
- Awareness of this severe adverse event is crucial for patient safety, particularly in elderly patients or those with renal impairment.
- This case underscores the potential for fatal outcomes associated with ticlopidine therapy.