Cholestatic hepatitis due to a therapy with ticlopidine

A 71-year-old man with chronic atrial fibrillation was treated with aspirin because of a right cerebral infarction. Oral anticoagulation was not initi ated because of a secondary hemorrhagic transformation. Six years later aft er a left cerebral transient ischemic attack aspirin was replaced by ticlop idine. Two weeks after starting ticlopidine he experienced abdominal cramps and diarrhea. Also dark urine and gray-colored stools were noticed, so tha t the patient stopped taking ticlopidine. 40 days after starting ticlopidin e he was admitted to our hospital because of cholestatic jaundice. Serum al kaline phosphatase (305 U/I) and gamma GT (143 U/I) were elevated, the tota l bilirubin was 18,6 mg/dl at peak. COT and GPT were 2,7 fold increased. Af ter exclusion of a viral infection and autoimmune disease liver biopsy was performed, which showed a centroacinar cholestasis compatible with a drug-i nduced liver damage. 79 days after discontinuation of the drug laboratory s igns of cholestasis had disappeared. In patients in whom long-term therapy with ticlopidine is indicated regular ly laboratory tests and clinical examinations should be done to recognize i nfrequent side effects such as the cholestatic hepatitis in time.