Key result
Clopidogrel use linked to severe cholestatic liver injury, confirmed by rechallenge and liver biopsy.
Why the study?
Clopidogrel is a widely prescribed antiplatelet agent rarely associated with hepatotoxicity, posing a diagnostic challenge in drug-induced liver injury.
Case Report (n=1)
No
This case demonstrates that clopidogrel can rarely cause severe cholestatic drug-induced liver injury, highlighting the importance of considering this etiology in patients presenting with unexplained cholestasis on dual antiplatelet therapy.
Clinicians should consider clopidogrel in unexplained cholestasis on DAPT; case report leaves incidence and mechanisms open.
Drug-induced liver injury remains a diagnostic challenge. Clopidogrel, a widely prescribed antiplatelet agent, is rarely associated with hepatotoxicity. We present a case of severe cholestatic liver injury temporally related to clopidogrel use. Extensive evaluation excluded other etiologies, including biliary obstruction, autoimmune hepatitis, primary biliary cholangitis, and viral hepatitis. Liver biopsy demonstrated cholestasis with ductular reaction, and serial liver function tests showed a reproducible pattern of alkaline phosphatase elevation and decline corresponding to clopidogrel administration and withdrawal. This case highlights the importance of considering clopidogrel-induced cholestatic drug-induced liver injury in patients on the medication who develop unexplained cholestasis.
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Yuen et al. (2026) conducted a case report in Cholestatic drug-induced liver injury (n=1). Clopidogrel was evaluated on Development of cholestatic liver injury (alkaline phosphatase elevation). Clopidogrel use was associated with severe cholestatic liver injury, evidenced by biopsy findings and a reproducible rise and fall in alkaline phosphatase levels upon rechallenge and withdrawal.
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