DOI: 10.12890/2023_004045
Thrombocytopenia induced by clopidogrel: a rare adverse effect
Authors
catarinatavoramr@gmail.com
Keywords
Thrombocytopenia, ITP, clopidogrel, TPO-RA, romiplostimAbstract
Introduction: Immune thrombocytopenic purpura (ITP) can be induced by several drugs but there are few case reports of ITP induced by clopidogrel. Second-line treatment with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids.
Case description: We report the case of a 79-year-old male who developed severe immune thrombocytopenic purpura after initiating treatment with clopidogrel. Because he needed elective orthopaedic surgery and he did not respond to corticotherapy and immunoglobulin, second-line treatment with romiplostim was initiated with a significant increase in platelet count.
Discussion and conclusion: Clopidogrel can induce ITP and this diagnosis should be considered in patients who present with isolated thrombocytopenia. First-line therapy of ITP is not always successful; second-line treatment with TPO-RA has a high response rate and should be considered in patients in need of elective surgery who have failed to respond to first-line therapy.
References
- li>Karakus V, Deveci B, Kurtoglu E, Arslan S. Early profound secondary autoimmune thrombocytopenia induced by clopidogrel in a patient with a coronary artery stent. Turkish J Hematol. 2012;29:94–95.
- Lozano ML, Sanz MA, Vicente V. Guidelines of the Spanish ITP Group for the diagnosis, treatment and follow-up of patients with immune thrombocytopenia. Med Clínica (English Ed.) 2021;157:191–198.
- DeLoughery TG. Immune Thrombocytopenia. In: DeLoughery TG, editor. Hemostasis and Thrombosis: Fourth Edition, New York: Springer International Publishing; 2019, p. 73–79.
- Campbell KL, Cohn JR, Savage MP. Clopidogrel hypersensitivity: clinical challenges and options for management. Expert Rev Clin Pharmacol 2010;3:553–561.
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–245.
- Balamuthusamy S, Arora R. Hematologic adverse effects of clopidogrel. Am J Ther 2007;14:106–112.
