TICLOPIDINE-ASSOCIATED PANCYTOPENIA - IMPLICATIONS OF AN ACETYLSALICYLIC-ACID ALTERNATIVE

Ticlopidine is an antiplatelet agent that has been proven efficacious in preventing vascular events in patients with a history of vasculopat hy. Neutropenia is a significant adverse effect and pancytopenia is ra rely reported. A fatal case of pancytopenia associated with unmonitore d use of ticlopidine is presented. A 59-year-old woman presented with severe pneumonia and profound neutropenia (absolute neutrophil count 0 %). She deteriorated with development of acute respiratory distress sy ndrome and a marked reduction in trilineage hematopoiesis. Despite pro mpt marrow response to granulocyte macrophage colony-stimulating facto r (GM-CSF) and cessation of ticlopidine, appropriate antibiotics and o ther supportive therapy, she died 17 days after admission. Hematologic al monitoring is imperative to identify potential complications: if di scovered late, there may be a role for GM-CSF for marrow support. Ticl opidine is indicated for patients intolerant of or nonresponsive to ac etylsalicylic acid therapy. As the use of ticlopidine increases, clini cians must be aware of potential life-threatening complications associ ated with its use and monitor appropriately.