Ticlopidine may cause hematologic or hemorrhagic side effects, (see "Side effects").
Hematological disorders are mainly associated with leukocytes. In the vast majority of cases, these side effects manifest themselves during the first three months of treatment. Sometimes there are severe cases (severe neutropenia, agranulocytosis), which can lead to death.
Severe outcomes of hematologic or hemorrhagic side effects are more likely to occur under the following conditions:
Non-compliance with control measures, late diagnosis and inadequate therapeutic intervention;
Co-administration of anticoagulants or platelet aggregation inhibitors such as aspirin and NSAIDs.
Hematological control
At the beginning of treatment, a differentiated clinical blood test (including platelet count) should be performed, and then it should be repeated every two weeks during the first three months of therapy. If treatment is discontinued during the first three months, within two weeks after cessation of treatment, neutrophil and platelet control is necessary.
In the case of neutropenia (<1500 neutrophils / mm3) or thrombocytopenia (<100,000
thrombocytes / mm3), treatment should be discontinued, and control blood tests with platelet count and other blood elements should be performed until normal results are obtained.
Control of hemostasis
Ticlopidine should be used with caution in the risk of bleeding (see "Interactions with other drugs").
If the patient is to undergo surgery, if the effect of platelet suppression is undesirable, treatment should be stopped at least ten days before surgery.
In the case of urgent surgery, three methods can be used together or separately to reduce the risk of bleeding and reduce bleeding time:
1) injection of 0.5-1.0 mg / kg of methylprednisolone intravenously, which can be repeated;
2) administration of desmopressin in a dose of 0.2-0.4 μg / kg;
3) transfusion of fresh platelets in the form of a platelet concentrate. Clinical control
All patients taking
ticlopidine, should be informed that the occurrence of fever, sore throat, ulceration in the oral cavity, prolonged or unusual bleeding, bruising, bloody vomiting and stool (melena) requires the patient to immediately seek medical attention.
The clinical diagnosis of thrombotic thrombocytopenic purpura (TTP) can be put in the presence of thrombocytopenia, hemolytic anemia, neurological symptoms, kidney dysfunction and high temperature. The beginning may be unexpected. Most of the cases were recorded in the first 8 weeks after the initiation of therapy. The prognosis is very serious (deaths from TTP are known).
The drug should be used with caution in patients with impaired liver function, and in the case of hepatitis or jaundice, treatment should be discontinued.
With severe diarrhea, treatment should be stopped.