Overlooked hepatotoxicity with Clopidogrel
Clopidogrel is an adenosine diphosphate receptor blocker. It is widely used as a part of dual antiplatelet therapy (DAPT) in patients with ischemic heart disease (IHD), regardless of the acute coronary syndrome (ACS). Although a rarely reported entity, clopidogrel-induced liver injury is commonly seen in clinical practice. It is widely overlooked by clinicians and is thus a potential hazard to patients with IHD.
Gong IY, Crown N, Suen CM, Schwarz UI, Dresser GK, Knauer MJ, et al. Clarifying the importance of CYP2C19 and PON1 in the mechanism of clopidogrel bioactivation and in vivo antiplatelet response. Eur Heart J. 2012; 33(22):2856-2464.
Ferguson JJ. Clopidogrel plus aspirin in patients with acute myocardial infarction treated with fibrinolytic therapy--CLARITY-TIMI 28. Future Cardiol. 2005; 1(5):605-610.
Wiviott S.D, Antman E.M, Gibson C.M, Montalescot G, Riesmeyer J, Weerakkody G, et al. Evaluation of prasugrel compared with clopidogrel in patients with acute coronary syndromes: design and rationale for the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38). Am Heart J. 2006; 152(4):627-635.
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996 Nov 16; 348(9038):1329-39.
Gerschutz GP, Bhatt DL. The CURE trial: using clopidogrel in acute coronary syndromes without ST-segment elevation. Cleve Clin J Med. 2002; 69(5):377-8.
Garton M. COMMIT/CCS-2 studies. Lancet. 2006; 368(9536):642-643.
López-Vicente J, Garfia C, López-Medrano F, Yela C. Hepatic toxicity and clopidogrel-induced systemic inflammatory response syndrome. Rev Esp Cardiol. 2007; 60(3):323-4.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury (Internet). Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Clopidogrel.
Wiper A, Schmitt M, Roberts DH. Clopidogrel-induced hepatotoxicity. J Postgrad Med. 2008; 54(2):152.
Moriyama B, Obeng AO, Barbarino J, Penzak SR, Henning SA, Scott SA. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C19 and Voriconazole Therapy. Clin Pharmacol Ther. 2017; 102(1):45-51.
Keshmiri H, Behal A, Shroff S, Berkelhammer C. Clopidogrel-Induced Severe Hepatitis: A Case Report and Literature Review. Case Reports Hepatol. 2016.
Copyright (c) 2020 Journal of Shifa Tameer-e-Millat University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Journal of Shifa Tameer-e-Millat University (JSTMU) is the owner of all copyright to any work published in the journal. Any material printed in JSTMU may not be reproduced without the permission of the editors or publisher. The Journal accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing and/or decision in this journal. The Editorial Board makes every effort to ensure the accuracy and authenticity of material printed in the journal. However, conclusions and statements expressed are views of the authors and do not necessarily reflect the opinions of the Editorial Board or JSTMU.
Content of this journal is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.