Ticlopidine and fatal aplastic anemia in an elderly woman.

OBJECTIVE

To report a case of aplastic anemia that developed during ticlopidine treatment.

CASE SUMMARY: An 84-year-old woman was started on ticlopidine for secondary stroke prevention. Within six weeks of initiating ticlopidine therapy she developed aplastic anemia. She was hospitalized and received empiric antibiotics, antifungal agents, blood transfusions, platelets, and granulocyte colony-stimulating factor. The patient died on day 76 after beginning ticlopidine.

DISCUSSION: Hematologic effects such as neutropenia, thrombocytopenia, agranulocytosis, thrombotic thrombocytopenic purpura, and pancytopenia have been described with the use of ticlopidine. Previous case reports have associated ticlopidine with the development of aplastic anemia.

CONCLUSIONS

Ticlopidine can produce fatal hematologic adverse effects, and its use should be reserved as second-line therapy.