2000 Associates' Presentations
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Ticlid-Induced Neutropenia

Sepideh Kazemi, MD, Mark Gennis, MD, Sinai Samaritan Medical Center, Milwaukee, WI

Introduction: Ticlopidine is an antiplatelet agent that irreversibly blocks fibrinogen binding to platelets. It has been used for over a decade for prophylaxis of cerebrovascular thromboembolism and thrombosis of intracoronary stenting. Ticlid has been associated with multiple hematological adverse effects including neutropenia, reported in up to 2.3% of cases. Neutropenia occurs from one to three months after initiation of the drug and generally resolves within three weeks of discontinuing. Monitoring CBS's is recommended every two weeks while taking Ticlid and for two weeks after stopping. We are presenting a case of severe Ticlid-induced neutropenia occurring over one month after the drug was discontinued.

Case: The patient is an 89-year old immigrant from the former Soviet Union, who was started on Ticlid as an outpatient after a presumed TIA. A CBC was obtained two weeks after beginning Ticlid and was normal. He took the medicine for 30 days and stopped when the pills ran out. He did not refill the prescription. One month after he stopped Ticlid, he presented with fever and cellulitis of the left foot. His admitting CBC showed a WBC of 400 with 14% PMN's, platelets of 72K and hemoglobin and hematocrit of 13.9/39. He developed pseudomonas sepsis and a pseudomonal necrotizing foot ulcer. He was treated with GCSF, antibiotics, debridement and skin grafting and left the hospital one month after admission. His WBC slowly improved and normalized after one week as did his platelet count.

Conclusion: This case is unusual in that severe neutropenia developed one month after the drug was stopped. Ticlid has a long half-life which likely was increased due to the patients advanced age. Ticlid must thus be used with particular caution in the elderly and CBC's monitored at least for one month after its discontinuation.

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