Key result
A 74-year-old man successfully recovered from drug-induced agranulocytosis and repeated stent thrombosis after discontinuing clopidogrel and transitioning to an alternative antiplatelet regimen of aspirin and sarpogrelate.
Case Report (n=1)
No
This case highlights the rare but severe complication of drug-induced agranulocytosis and repeated stent thrombosis, demonstrating the challenge of managing antiplatelet therapy in such complex scenarios.
Alternative regimen may be viable in clopidogrel agranulocytosis with thrombosis; leaves open need for confirmatory studies.
A 74-year old Japanese male was admitted for acute myocardial infarction and underwent implantation of a bare metal stent for total occlusion of the right coronary artery (RCA). He developed acute stent thrombosis (ST) at the implantation site, and was re-treated using balloon angioplasty. Two weeks after discharge he presented to the emergency department with a sore throat and was admitted for treatment of agranulocytosis and esophageal candidiasis. During the first night of hospitalization, his vital signs indicated that he was experiencing cardiogenic shock. An electrocardiogram revealed a junctional rhythm with ST-segment elevations in the inferior leads. An emergency coronary angiography showed total occlusion of the RCA at the site of stent placement. Late ST was diagnosed, and intra-aortic balloon pumping was performed, followed by another thrombectomy and balloon angioplasty. Drug-induced agranulocytosis was highly suspected, and all drugs prescribed to the patient with the exception of aspirin were discontinued. He experienced a smooth recovery and a regimen of sarpogrelate and cilostazol was begun on Day 4 of hospitalization. On Day 7, he presented melena complicating hemorrhagic shock. Therefore, all drugs including aspirin were discontinued. The decision was made to replace clopidogrel with another antithrombotic agent in order to obtain adequate platelet inhibition. Thus while unfractionated heparin continued to be administered, aspirin was begun on Day 19 and sarpogrelate on Day 27. The patient was discharged on Day 34 and his treatment course was good. Thus far the patient has been free of chest pain and has had no need of further hospitalization.
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Nishimura et al. (2016) conducted a case report in Drug-induced agranulocytosis and repeated stent thrombosis (n=1). Sarpogrelate and aspirin was evaluated. A 74-year-old man successfully recovered from drug-induced agranulocytosis and repeated stent thrombosis after discontinuing clopidogrel and transitioning to an alternative antiplatelet regimen of aspirin and sarpogrelate.
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