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Original Articles

Frequency of Allergic or Hematologic Adverse Reactions to Ticlopidine Among Patients With Allergic or Hematologic Adverse Reactions to Clopidogrel

Juzar O. Lokhandwala, MD, RVT; Patricia J.M. Best, MD; Joseph H. Butterfield, MD; Kimberly A. Skelding, MD; Thomas Scott, DO; James C. Blankenship, MD; Jeremy W. Buckley, MD and Peter B. Berger, MD

From the Department of Cardiology (J.O.L., K.A.S., T.S., J.C.B., J.W.B., P.B.B.) and Center for Clinical Studies (P.B.B.), Geisinger Medical Center, Danville, Pa; and Divisions of Cardiovascular Diseases (P.J.M.B.) and Allergic Diseases (J.H.B.), Mayo Clinic, Rochester, Minn.

Correspondence to Peter B. Berger, MD, Geisinger Center for Health Research, 100 North Academy Avenue, MC 44-00, Danville, PA 17822-3003. E-mail pbberger{at}geisinger.edu

Received November 4, 2008; accepted June 10, 2009.

Background— Clopidogrel and ticlopidine are structurally very similar. In patients with an allergic or hematologic adverse reaction to either one of these drugs, the likelihood that an allergic or hematologic adverse effect will develop to the other is unknown. It is also unknown whether a reaction to the second thienopyridine is likely to be life threatening.

Methods and Results— Medical records from 2 academic institutions were reviewed to identify patients who had an allergic or hematologic adverse reaction to either of the 2 currently commercially available thienopyridines and who were subsequently prescribed the other thienopyridine. Patient demographics, details of the adverse reactions, and subsequent clinical course were reviewed. A total of 76 patients were identified with an allergic or hematologic adverse reaction to clopidogrel or ticlopidine who had also received the other thienopyridine. Fourteen (27%; 95% CI, 16 to 41) patients who had an allergic or hematologic adverse reactions to clopidogrel had a similar reaction to ticlopidine; none developed a life-threatening reaction. The most common reaction was a rash (93%).

Conclusions— In patients with an allergic or hematologic adverse reaction to one thienopyridine, there seems to be an increased frequency of such reactions to the other thienopyridine. However, no patient had a life-threatening reaction after exposure to the alternative thienopyridine.

Key Words: platelet aggregation inhibitors • hemorrhage • thienopyridine • clopidogrel • ticlopidine • allergy • cross-reactivity

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CLINICAL PERSPECTIVE

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