Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review
Abstract Background Clopidogrel is a widely-used antiplatelet and acts as an adenosine diphosphate receptor inhibitor. Neutropenia is a rare but serious adverse effect of clopidogrel. It is unknown whether this adverse effect has any association with impaired kidney function. Case presentation An 80...
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-022-02490-3 |
| _version_ | 1818284302755954688 |
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| author | Yannan Pan Bing Liu Junmeng Liu Wei Zhuang Qing He Ming Lan |
| author_facet | Yannan Pan Bing Liu Junmeng Liu Wei Zhuang Qing He Ming Lan |
| author_sort | Yannan Pan |
| collection | DOAJ |
| description | Abstract Background Clopidogrel is a widely-used antiplatelet and acts as an adenosine diphosphate receptor inhibitor. Neutropenia is a rare but serious adverse effect of clopidogrel. It is unknown whether this adverse effect has any association with impaired kidney function. Case presentation An 80-year-old male with chronic kidney disease was diagnosed with non-ST elevation myocardial infarction and underwent percutaneous coronary intervention. During hospitalization, the patient was diagnosed with contrast-induced nephropathy, treated symptomatically, and discharged with a back-to-baseline creatinine level. Two weeks later, the patient presented to the emergency department with fever and chills. Complete blood count showed leukopenia (0.84 × 103/mm3) and severe neutropenia (0.13 × 103/mm3). Blood cultures were positive for Pseudomonas aeruginosa. Clopidogrel was stopped immediately and switched into ticagrelor. Imipenem and granulocyte colony-stimulating factor were administered to the patient. The patient’s white blood cell and absolute neutrophil count were within the normal range after four days of treatment. The patient was discharged after a 10-day hospitalization, and his complete blood counts were normal during further follow-ups. Conclusions Clopidogrel was the most likely primary cause of neutropenia in our case. The incidence of clopidogrel-induced neutropenia is low and the exact mechanism is not fully explained. We provide suggestions on the management of clopidogrel-associated neutropenia, and summarize all five cases of clopidogrel-induced neutropenia in patients with impaired kidney function. |
| first_indexed | 2024-12-13T00:50:39Z |
| format | Article |
| id | doaj.art-a76c2d01b7524df8b12ac25053e44613 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-13T00:50:39Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-a76c2d01b7524df8b12ac25053e446132022-12-22T00:04:56ZengBMCBMC Cardiovascular Disorders1471-22612022-02-012211610.1186/s12872-022-02490-3Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature reviewYannan Pan0Bing Liu1Junmeng Liu2Wei Zhuang3Qing He4Ming Lan5School of Medicine, Peking University Health Science CenterDepartment of Cardiology, Beijing Hospital, National Center of GerontologyDepartment of Cardiology, Beijing Hospital, National Center of GerontologyDepartment of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Beijing Hospital, National Center of GerontologyDepartment of Cardiology, Beijing Hospital, National Center of GerontologyAbstract Background Clopidogrel is a widely-used antiplatelet and acts as an adenosine diphosphate receptor inhibitor. Neutropenia is a rare but serious adverse effect of clopidogrel. It is unknown whether this adverse effect has any association with impaired kidney function. Case presentation An 80-year-old male with chronic kidney disease was diagnosed with non-ST elevation myocardial infarction and underwent percutaneous coronary intervention. During hospitalization, the patient was diagnosed with contrast-induced nephropathy, treated symptomatically, and discharged with a back-to-baseline creatinine level. Two weeks later, the patient presented to the emergency department with fever and chills. Complete blood count showed leukopenia (0.84 × 103/mm3) and severe neutropenia (0.13 × 103/mm3). Blood cultures were positive for Pseudomonas aeruginosa. Clopidogrel was stopped immediately and switched into ticagrelor. Imipenem and granulocyte colony-stimulating factor were administered to the patient. The patient’s white blood cell and absolute neutrophil count were within the normal range after four days of treatment. The patient was discharged after a 10-day hospitalization, and his complete blood counts were normal during further follow-ups. Conclusions Clopidogrel was the most likely primary cause of neutropenia in our case. The incidence of clopidogrel-induced neutropenia is low and the exact mechanism is not fully explained. We provide suggestions on the management of clopidogrel-associated neutropenia, and summarize all five cases of clopidogrel-induced neutropenia in patients with impaired kidney function.https://doi.org/10.1186/s12872-022-02490-3ClopidogrelNeutropeniaCKDPCI |
| spellingShingle | Yannan Pan Bing Liu Junmeng Liu Wei Zhuang Qing He Ming Lan Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review BMC Cardiovascular Disorders Clopidogrel Neutropenia CKD PCI |
| title | Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review |
| title_full | Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review |
| title_fullStr | Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review |
| title_full_unstemmed | Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review |
| title_short | Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review |
| title_sort | clopidogrel induced neutropenia in an 80 year old patient with chronic kidney disease who underwent percutaneous coronary intervention a case report and literature review |
| topic | Clopidogrel Neutropenia CKD PCI |
| url | https://doi.org/10.1186/s12872-022-02490-3 |
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