Abstract
Clopidogrel has mostly replaced the use of ticlopidine due to its more favourable
hematologic adverse event profile. Prasugrel is the newest thienopyridine approved
for use in Canada. This case describes a patient who was diagnosed with an acute coronary
syndrome and treated with bare metal stenting of his coronary artery. He was discharged
home on clopidogrel therapy. Two weeks later he presented with severe neutropenia.
Clopidogrel was discontinued and prasugrel was initiated. Neutrophil count gradually
increased and returned to normal. In patients with neutropenia associated with clopidogrel
therapy, prasugrel may be considered as an alternative.
Résumé
Le clopidogrel a presque remplacé l'utilisation de la ticlopidine en raison de son
profil plus favorable en ce qui a trait aux événements hématologiques indésirables.
Le prasugrel est la plus récente thiénopyridine approuvée pour utilisation au Canada.
Ce cas décrit un patient ayant reçu un diagnostic de syndrome coronarien aigu et ayant
été traité par l'implantation d'un tuteur coronarien métallique. Il a obtenu son congé
de l'hôpital avec un traitement au clopidogrel. Deux semaines plus tard, il a présenté
une neutropénie sévère. Le clopidogrel a été cessé et le prasugrel a été introduit.
Le nombre de neutrophiles a augmenté graduellement pour revenir à la normale. Chez
les patients avec une neutropénie associée au traitement au clopidogrel, le prasugrel
peut être considéré comme une alternative.
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References
Ticlopidine. In: DRUGDEX System [intranet database]. Version 5.1. Greenwood Village, CO: Thomson Reuters (Healthcare) Inc.
- Overview of neutropenia.in: Basow D.S. UpToDate. UpToDate, Waltham, MA2010
- A randomized, blinded trial of Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE).Lancet. 1996; 348: 1329-1339
- Prasugrel versus clopidogrel in patients with acute coronary syndromes.N Engl J Med. 2007; 357: 2001-2015
- Severe neutropenia under clopidogrel treatment three weeks after coronary stenting.Thromb Haemost. 2007; 97: 317-318
Article info
Publication history
Published online: July 26, 2011
Accepted:
April 4,
2011
Received:
February 23,
2011
Footnotes
See page 869.e11 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
