Adverse cutaneous reactions to ticlopidine in patients with coronary stents

A prospective study was carried out to assess the occurrence and character of adverse cutaneous reactions in patients receiving ticlopidine hydrochlor ide to prevent subacute thrombosis after having undergone placement of coro nary stents. During a 1-year period such patients were requested to report adverse cutaneous reactions, and those with skin reactions were referred fo r dermatological evaluation. Among the 136 patients who underwent stent pla cement by one of the authors, 20 were referred for dermatological evaluatio n. Of these, 16 (11.8%) fit the case definition of ticlopidine-associated c utaneous reactions. In the first 8 consecutive patients ticlopidine was wit hdrawn (in 2 of these a rechallenge test as later performed); in the next 8 patients ticlopidine was not discontinued before completion of the intende d week period of treatment. Patients remained under weekly follow-up and un derwent a weekly blood count. Skin biopsies n;ere obtained in 5 patients wi th different types of eruptions. The skin reactions appeared from 2 to 21 d ays after commencement of ticlopidine (mean, 10 days), lasting from 2 to 30 days (mean, 5 days). Onlly 3 patients had other adverse effects: neutropen ia in 1 and abdominal pain and nausea in 2. The most common presentations w ere urticaria, pruritus. and maculopapular eruption. In 3 patients there we re previously unreported reactions: fixed drug eruption, erythromelalgia-li ke eruption, and erythema multiforme-like eruption. Of note was the rapid c learing of the skin eruption in most cases even a-hen the drug was not with drawn. It was concluded that adverse cutaneous reactions are relatively com mon in association with ticlopidine treatment but that serious reactions ar e rare and the disappearance of the signs and symptoms is rapid. suggesting that discontinuation of the drug is not usually imperative.