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Ticlopidine, a thienopyridine derivative, is widely used in Poland in vascular procedures. Ticlopidine-induced acute cholestatic hepatitis is a very rare adverse reaction. We present a case of a patient with possible ticlopidine-induced cholestatic hepatitis occurring a few days after introducing this drug.

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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.

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Severe ticlopidine-induced cholestatic syndrome.

Blood Purif

March 2008

UO Nefrologia, Dialisi e Ipertensione Malpighi, Policlinico S. Orsola-Malpighi, Bologna, Italy.

A patient with chronic renal insufficiency undergoing dialysis treatment presented with a clinical picture of acute intrahepatic cholestasis and alterations in liver function indices. Liver biopsy showed a histological picture of hepatitis with cholestatic signs. A causal correlation with the recent administration of ticlopidine was hypothesized, which led to the drug being discontinued.

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Ticlopidine-induced hepatotoxicity is associated with specific human leukocyte antigen genomic subtypes in Japanese patients: a preliminary case-control study.

Pharmacogenomics J

February 2008

Product Lifecycle Management Department, Daiichi Pharmaceutical Co. Ltd., 1-8 Nihonbashi-Koamicho, Chuo-ku, Tokyo, Japan.

Genetic risk factors for ticlopidine-induced hepatotoxicity were determined in 22 Japanese patients with ticlopidine-induced hepatotoxicity and 85 Japanese patients who tolerated ticlopidine therapy without experiencing adverse reactions. There was a significant correlation between ticlopidine-induced hepatotoxicity and five human leukocyte antigen (HLA) alleles: HLA-A*3303, HLA-B*4403, HLA-Cw*1403, HLA-DRB1*1302 and HLA-DQB1*0604 (corrected probability (P)-value (Pc)<0.01).

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