Ticlopidine – induced hepatic toxicity – three clinical case reports
Keywords:
Ticlopidine, cholestasis, drug - induced hepatitisAbstract
Ticlopidine is widely used nowadays. It has
occasionally been responsible for important
hepatotoxicity. We present three case reports of Ticlopidine-induced cholestatic hepatitis, recognised over the last years, at our institution. All three patients were male, with regular significant ethanol
intake. They all presented with serious symptomatic
cholestatic jaundice. Liver biopsy was performed in
all 3 patients and was consistent with toxic
cholestasis, and we emphasize the presence of
granulomas in two of them. In two patients alkaline
phosphatase, gamma-glutamyl transpeptidase and
cholesterol reached exceptionally high levels.
Although clinically well more than eleven months
after drug suspension, two patients still presented
laboratory evidence of cholestasis. One patient had
initially important but reversible anaemia of
unestablished aetiology. After a short general
introduction on the subject of acute hepatic drug
toxicity we compare our cases with other ticlopidine-induced cholestatic hepatitis case reports published
in the international literature.
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References
. Hass WK, Easton JD, Adams HD et al. A randomized trial comparing Ticlopidine hydrochloride with aspirin for the prevention of stroke
in high risk patients. N England J Med 1989; 321(8):501-507.
Gent M, Easton JD; Hachinski VC et al. The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. The Lancet
(6):1215-1220.
Janzon L, Bergqvist J, Boberg J et al. Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results of STIMS, the Swedish Ticlopidine Multicentre Study. Journal of internal Medicine 1990;227:301-308.
Lutomski DM, Bottorff M, Sangha K. Pharmacokinetic optimisation of the treatment of embolic disorders. Clin Pharmacokinet 1995, 28 (1):67-92.
Errando AD. Ataques isquémicos transitorios. In Manual de Enfermidades Vasculares Cerebrales. J.R. Prous Editores, 1995 Barcelona ( Espanha) 74-84.
. Khan MG. Antiplatelet agents, anticoagulants, specific thrombin inhibitors in the management of heart disease. In Cardiac Drug
Therapy, 4thEd. 1995 W.B. Saunders Company Ltd (London).
Product information, Ticlid ( ticlopidine). Mississauga, Ontario:Syntex 1993.
. Biour M, Poupon R, Grangé JD, Chazeouilleres O, Jaillon P. Hepatotoxicité des médicaments (12e mise à jour du fichier
bibliographique des atteintes hepátiques et des médicaments responsables).Gastroenterol Clin Biol 1999; 23 (12): 1310-1352.
. Larrey D. Hépatites aigües médicamenteuses- imputabilité et aspects cliniques. Gastroenterol Clin Biol 1995;19: B57-62.
Pessayre D, Larrey D. Acute and chronic drug -induced hepatitis. Ballière’s Clin. Gastroenterology 1988; 2(2):385-422.
Sherlock S, Dooley J. Drugs and the liver. In Diseases of the liver and biliary system. Sheila Sherlock & James Dooley Ed, 9thed.
, Blackwell Scientific Publications ( Oxford, London) 322-353.
Danan G. Définition et critéres d’imputation des atteintes hépatiques aigües médicamenteuses. Conclusion d’une reunion
internationelle de consensus. Gastroenterol Clin Biol 1993;17:H18-21.
Larrey D, Erlinger S. Drug induced-cholestasis. Ballière’s Clin Gastroenterology 1988; 2(2):423-452.
Biour M, Toussaint P, Duhamel G Canuel C, Krulick M, Calmus Y. Ticlopidine: atteintes sanguins et hépatiques? Thérapie 1982;
:217-224.
Yoder JD, Algozzine GJ, Hill GW. More ticlopidine-induced cholestatic jaundice. Am J Hosp Pharm 1994; 51:1821-1822.
Grieco A, Vecchio FM, Greco AV, Gasbarrini G. Cholestatic hepatitis due to ticlopidine: Clinical and histological recovery after drug
withdrawal. Case report and riview of the Literature. Eur J Gastroenterol Hepatol 1998; 10 (8): 713-715.
Sanchez-Bisono JR, Gomez-Moli J, Escudero-Canto M. Probable ticlopidine – induced severe aplastic anemia and cholestatic
hepatitis. Haematologica 1997 ; 82 (5): 639.
Saint-Marc Girardin MF, Cordonnier C. Ictére cholestatique et agranulocytose dus à ticlopidine. Gastroenterol Clin Biol 1982;
:716-717.
Ruiz Valverde P, Zafon C, Segarra A, Ribera R, Piera L. Ticlopidinainduced granulomatous hepatitis. The Ann Pharmacotherapy
;29:633.
Amaro P, Nunes A, Macoas F et al. Ticlopidine – induced prolonged cholestasis: a case report. Eur J Gastroenterol Hepatol 1999 ;11
(6): 673-676.
Deschamps JP, Lassègue A, Ottignon Y et al. Ictère cholestatique associé à la prise de ticlopidine:à propos des deux premiers cas.
Gastroenterol Clin Biol1982; 6:595-596.
Sousa C, Correia J, Santos J et al. Hepatites medicamentosas – a propósito de dois casos associados à claritromicina e à ticlopidina.
Arquivos de Medicina 1997; 11 (3): 147 – 150.
Colivicchi F, Magnanimi S, Sebastiani F, Silvestri R, Magnanimi R. Ticlopidine-induced chronic cholestatic hepatitis: a case report.
Current Therapeutic Research 1994;55(8):929-931.
Berglund U, Wallentin L. Influence on lipoprotein metabolism of the platelet inhibitory drug ticlopidine. Atherosclerosis
;59:241.
Fred HL, Hariharan R, Doucet J, Mehta N. Jaundice and extreme hypercholesterolemia after a stroke. Hosp Pratice 1996:33-37.
Naschitz JE, Khamessi R, Elias N, Yeshurun D. Ticlopidine-induced prolonged cholestasis. Clinical Toxicology 1995;33(4):379-380.
Artímez ML, Fernandez E, Rodriguez M. Gonzalez M, Rodrigo I. et al. Ticlopidina-induced toxic hepatitis. Three new cases. Rev
Esp Enf Digest 1997;89(10):796-797
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