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Calogiuri GF, Al-Sowaidi S, Nettis E, Cortellini G, Macchia L, Vacca A, Kounis NG. A joint allergist/cardiologist classification for thienopyridines hypersensitivity reactions based on their symptomatic patterns and its impact on the management strategies. Int J Cardiol 2016; 222:509-514. [PMID: 27505343 DOI: 10.1016/j.ijcard.2016.07.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/08/2016] [Indexed: 11/15/2022]
Abstract
The role and importance of thienopyridines such as ticlopidine, clopidogrel, and prasugrel is well-established for several indications, ranging from prevention of acute coronary syndromes to percutaneous coronary interventions, where the dual antiplatelet therapy represents the gold standard to avoid denovo coronary stenosis. However, there is a significant cohort of patients with coronary artery disease who may manifest hypersensitivity reactions to thienopyridines. The examination of the various case reports from medical literature leads to identify mainly four clinical patterns of hypersensitivity to thienopyridines which involves more frequently cutaneous, hematologic, and articular tissues, therefore the kind and predominance of clinical symptoms may determine a different clinical approach to overcome or neutralize thienopyridines hypersensitivity.
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Affiliation(s)
- G F Calogiuri
- Pneumology Department Civil Hospital "NinettoMelli"S. Pietro Vernotico, Brindisi, Italy; Section of Allergology and Clinical Immunology, Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Bari, Italy.
| | - S Al-Sowaidi
- Department of Internal Medicine, UAE University, Al-Ain, United Arab Emirates
| | - E Nettis
- Section of Allergology and Clinical Immunology, Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Bari, Italy
| | - G Cortellini
- Internal Medicine Allergy and Rheumatology Unit, Rimini Hospital, Rimini, Italy
| | - L Macchia
- Section of Allergology and Clinical Immunology, Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Bari, Italy
| | - A Vacca
- Department of Biomedical Science and Human Oncology, Section of Internal Medicine and Clinical Oncology University of Bari Medical School, Bari, Italy
| | - N G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Achaia, Greece
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Yoshikado T, Takada T, Yamamoto H, Tan JK, Ito K, Santa T, Suzuki H. Ticlopidine, a Cholestatic Liver Injury-Inducible Drug, Causes Dysfunction of Bile Formation via Diminished Biliary Secretion of Phospholipids: Involvement of Biliary-Excreted Glutathione-Conjugated Ticlopidine Metabolites. Mol Pharmacol 2012; 83:552-62. [DOI: 10.1124/mol.112.081752] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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3
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Un caso di epatite colestatica da ticlopidina: descrizione del caso e revisione della letteratura. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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4
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Callison RC, Adams HP. Use of antiplatelet agents for prevention of ischemic stroke. Neurol Clin 2008; 26:1047-77, ix. [PMID: 19026902 DOI: 10.1016/j.ncl.2008.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Overall management to lower risk for ischemic stroke is multifaceted. Management includes measures to treat risk factors for accelerated atherosclerosis and stroke, antithrombotic therapies to lower the risk for thromboembolism, and surgery to treat a defined arterial or cardiac lesion. Treatment decisions are made on a case-by-case basis, with most patients receiving some combination of medication and recommendations for lifestyle modification. Some patients will also undergo surgical or endovascular interventions. This article discusses antithrombotic treatment for ischemic stroke prevention, placing major emphasis on the indications for and administration of antiplatelet therapy.
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Affiliation(s)
- R Charles Callison
- Division of Cerebrovascular Diseases Department of Neurology, Carver College of Medicine University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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5
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Lee JY, Park EB, Ahn JH, Suh SJ, Jung YK, Kim JH, Shin BK, Yang JH, Yeon JE, Byun KS. [A case of ticlopidine induced acute cholestatic hepatitis and pure red cell aplasia]. THE KOREAN JOURNAL OF HEPATOLOGY 2008; 14:102-7. [PMID: 18367863 DOI: 10.3350/kjhep.2008.14.1.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ticlopidine inhibits platelet aggregation and provides beneficial secondary prevention of cerebrovascular and coronary artery disease. Frequently reported adverse effects of ticlopidine include diarrhea, nausea, and rash. However, to our knowledge, there are only a few published reports of the simultaneous occurrence of cholestatic hepatitis and pure red cell aplasia. Here we report a patient with simultaneous severe cholestatic hepatitis and pure red cell aplasia associated with ticlopidine. Although these adverse effects are rare, periodic hematological and liver function tests are recommended after starting ticlopidine.
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Affiliation(s)
- Ji Yeon Lee
- Korea University Medical College Guro Hospital, Department of Internal Medicine, Seoul, Korea
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6
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Mambelli E, Mancini E, Casanova S, Di Felice A, Santoro A. Severe Ticlopidine-Induced Cholestatic Syndrome. Blood Purif 2007; 25:441-5. [DOI: 10.1159/000111033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 07/19/2007] [Indexed: 11/19/2022]
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Schleinitz MD, Olkin I, Heidenreich PA. Cilostazol, clopidogrel or ticlopidine to prevent sub-acute stent thrombosis: a meta-analysis of randomized trials. Am Heart J 2004; 148:990-7. [PMID: 15632883 DOI: 10.1016/j.ahj.2004.03.066] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sub-acute thrombosis is a serious complication of coronary artery stenting. Clopidogrel plus aspirin is the accepted prophylactic regimen, but has yet to be proven superior to ticlopidine plus aspirin, and a new regimen combining cilostazol and aspirin has been introduced. METHODS We conducted a meta-analysis of all trials that compared >or=2 oral anti-thrombotic strategies in patients undergoing coronary stent placement to determine which treatment optimally prevents adverse cardiac events in the 30 days following stent insertion. We used meta-regression to compare all strategies to a shared control strategy: ticlopidine plus aspirin. We also compared randomized trials to historically controlled and other non-randomized trials. We conducted sensitivity analysis and subgroup analysis to assess for possible heterogeneity. RESULTS In comparison to ticlopidine plus aspirin the odds-ratios for cardiac events, with 95% confidence intervals were: aspirin alone, 4.29 (3.09-5.97), coumadin plus aspirin, 2.65 (2.18-3.21), clopidogrel plus aspirin, 1.06 (0.86-1.31), cilostazol plus aspirin, 0.73 (0.47-1.14). Among trials that compared clopidogrel plus aspirin to ticlopidine plus aspirin, historically controlled trials were statistically distinct from randomized trials. The analysis of cilostazol was sensitive to the small size of the included studies. CONCLUSIONS Neither clopidogrel plus aspirin nor cilostazol plus aspirin can be statistically distinguished from ticlopidine plus aspirin for the prevention of adverse cardiac events in the 30 days after stenting. A randomized trial including cilostazol is warranted.
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Affiliation(s)
- William M Lee
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9151, USA.
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9
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Abstract
NSAIDs are one of most frequently prescribed agents in clinical practice. Whereas hepatotoxicity is a rare complication of most NSAIDs (typically 1 to 10 per 100,000 persons exposed), the high level of usage means that these drugs cause liver disease. Because of their divergent chemical structures, the mechanisms and clinicopathological manifestations of hepatotoxicity vary widely. The reactive metabolite syndrome, in which serious rash, eosinophilia, and other forms of tissue injury are common, may be incited by several NSAIDs, including newer agents. Women, people aged more than 50 years, and for some drugs, the type of arthritis, may be risk factors for drug-induced liver injury. The spectrum of NSAID-drug related hepatotoxicity continues to expand, with reports of interactive toxicity in adults with hepatitis C and recognition of rare cases of liver disease associated with non-selective, selective, and preferential COX-2 inhibitors. Better outcomes require people taking NSAIDs to be aware of possible drug reactions involving the liver, and prescribers should be vigilant for early symptoms of hepatotoxicity so that incriminated agents are discontinued promptly.
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Affiliation(s)
- Narci C Teoh
- Storr Liver Unit, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Darcy Road, PO Box 412, Westmead, New South Wales 2145, Australia
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10
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Abstract
A 77-year-old woman developed jaundice and anemia 3 and 8 weeks, respectively, after starting ticlopidine (100 mg daily) for cerebral infarction. From the laboratory findings, including histological study of the liver and bone marrow specimen, ticlopidine-induced intrahepatic cholestasis and pure red cell aplasia were highly suspected. Jaundice slowly improved after the withdrawal of ticlopidine. Anemia immediately improved with steroid therapy. These are very rare adverse effects of ticlopidine; nevertheless, periodic laboratory examinations are recommended.
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Affiliation(s)
- Nobuo Waguri
- Department of Internal Medicine, Sannocho Hospital, 2-30 Honcho 5, Sanjo City, 955-0071, Niigata, Japan
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Abstract
Fulminant liver disease, acute liver failure (ALF), is one of the most intriguing and challenging conditions in the entire field of internal medicine. ALF is defined as the onset of hepatic encephalopathy and coagulopathy in patients with no known underlying liver disease within 8 to 26 weeks of onset of illness. Many cases develop within a few days, dramatically transforming an otherwise healthy individual to a patient with a high risk for developing multi-organ failure and death.
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Affiliation(s)
- Frank Vinholt Schiødt
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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12
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Ramos Ramos JC, Sanz Moreno J, Calvo Carrasco L, García Díaz JDD. [Clopidogrel-induced hepatotoxicity]. Med Clin (Barc) 2003; 120:156-7. [PMID: 12605844 DOI: 10.1016/s0025-7753(03)73632-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zapater P, Such J, Pérez-Mateo M, Horga JF. A new Poisson and Bayesian-based method to assign risk and causality in patients with suspected hepatic adverse drug reactions: a report of two new cases of ticlopidine-induced hepatotoxicity. Drug Saf 2002; 25:735-50. [PMID: 12167069 DOI: 10.2165/00002018-200225100-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The diagnosis of drug-induced hepatotoxicity is based on circumstantial evidence and is often inaccurate. We have designed a method based on published data to assign causality to suspected cases of drug-induced hepatotoxicity. DESIGN Forty-seven published cases of ticlopidine-induced hepatotoxicity were identified by a Medline-based literature search. Data regarding abnormal liver function in patients receiving ticlopidine were obtained from the only published placebo-ticlopidine clinical trial (the Canadian American Ticlopidine Study; CATS). Thus, we calculated the maximum number of expected hepatotoxicity cases in patients exposed to ticlopidine and those not exposed to the drug by means of the Poisson distribution. The calculated odds ratio was used as a prior odd for subsequent quantification, using a Bayesian-based approach, of individual ticlopidine-induced hepatotoxicity likelihood. Concretely, the prior odd is modified by several separate likelihood ratios: age; sex; AST level; ALT level; alkaline phosphatase level; total bilirubin level; latent period of adverse reaction appearance; and period of remission of adverse reaction. This methodology was applied to two new cases of suspected ticlopidine-induced hepatotoxicity. RESULTS The prior probability of ticlopidine-induced hepatotoxicity derived from CATS data is 61.29%. This is in contrast with the 28.83% incidence rate of drug-induced liver alterations in the general population. Alkaline phosphatase levels and total bilirubin levels were six times the normal values among individuals with ticlopidine-induced hepatotoxicity than in the general population. They were the most relevant likelihood ratios of the Bayesian model to establish a high level of causality relationship between a hepatotoxicity event and ticlopidine use. CONCLUSIONS The proposed method, which links information from clinical trials with the profile of clinical hepatotoxicity of a drug defined from published cases reported after a drug is marketed, can be a useful tool for drug postmarketing surveillance research.
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Affiliation(s)
- Pedro Zapater
- Clinical Pharmacology Unit, University General Hospital of Alicante and Department of Pharmacology and Therapeutics, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain.
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Alberti L, Alberti-Flor JJ. Ticlopidine-induced cholestatic hepatitis successfully treated with corticosteroids. Am J Gastroenterol 2002; 97:1072. [PMID: 12003401 DOI: 10.1111/j.1572-0241.2002.05642.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
The incidence of drug-induced liver disease appears to be increasing, reflecting the increasing number of new agents that have been introduced into clinical use over the past several decades. Among the topics covered, the author discusses incidence, diagnosis, risk factors, clinical presentations, hepatitis, and vascular injury. The author also reviews the hepatic injury seen with commonly prescribed drugs, emphasizing newer developments in the field and recent publications and reports.
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Affiliation(s)
- J H Lewis
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Gallerani M, Manfredini R, Doneg?? P, Lanza F, Da Busti M, Vigna GB, Fellin R. Adverse Haematological Effects of Ticlopidine. Clin Drug Investig 2000. [DOI: 10.2165/00044011-200019030-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
The past year has seen several additions to the list of drugs that cause hepatic injury. Many of these agents produce fulminant hepatic necrosis and, in some cases, were withdrawn from the market (eg, bromfenac). Other drugs had warnings placed in their labeling along with stringent monitoring guidelines to alert physicians and patients alike to the potential for severe hepatic injury (eg, troglitazone, tolcapone). New reports of hepatoxicity continued to appear for many older agents, in some cases expanding the hepatotoxic spectrum for the drugs. Vanishing bile duct syndrome has drawn increasing attention and is now associated with more than 30 drugs. Ibuprofen is among those drugs newly described as causing this syndrome. Hepatitis C virus infection was reported as a possible risk factor for ibuprofen hepatotoxicity, raising the issue of safe use of nonprescription as well as prescription drugs in patients with underlying liver disease. Reports have appeared about acetaminophen-induced hepatotoxicity in several dozen children from unintentional overdoses, in addition to cases of therapeutic misadventure in adults.
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Affiliation(s)
- W Mayoral
- Georgetown University Medical Center, Washington, DC, USA
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