Hepatitis Linked to Antiplatelet Drug Clopidogrel

A case report published in Case Reports in Hepatology describes a patient suffering from severe hepatitis induced by a commonly prescribed antiplatelet medication.

The patient, a 34-year-old male, presented with jaundice and fatigue but denied any abdominal pain, fever, rash, joint pain, or any recent consumption of alcohol or herbal supplements. His medical history included coronary artery disease and a coronary artery stent and he had been prescribed clopidogrel and aspirin. His baseline liver function tests were normal at that time, MPR reports. He had been on clopidogrel for 4.5 months before coming in with these symptoms. He had taken clopidogrel without incident 12 years earlier without incident and had discontinued the drug on his own, the authors report.

Apart from jaundice, the man had no other signs of chronic liver disease. A number of tests, including hepatitis A, B, C, E, cytomegalovirus, and Epstein-Barr virus were negative, but a liver biopsy revealed severe acute hepatitis with mixed inflammatory portal tract infiltrates. After doctors reviewed all tests they diagnosed the patient with clopidogrel-induced severe hepatitis and he was taken off clopidogrel. Even after clopidogrel was discontinued, he had some abnormal liver tests and he was given prednisone and ursodiol, after which his liver tests normalized, MPR reports. .

Though drug-induced hepatitis is a rare side effect, it has been described in other case reports, with the degree of damage ranging from reversible liver injury to acute liver failure and death. Some of the cases were confirmed when patients were given clopidogrel again; the onset of injury ranged from three to 180 days. In this case, onset was delayed, as the patient had been on the drug for 4.5 months before presenting with symptoms. This delay suggests the mechanism by which clopidogrel causes hepatocellular injury may have a toxic-metabolic etiology, but the patient’s response to corticosteroids also points to the possibility of an immune-mediated mechanism. Studies have suggested the active metabolite of clopidogrel may be responsible for hepatotoxicity.

Clopidogrel (Plavix) is a blood thinner used to prevent heart attacks and strokes in people with heart disease, blood circulation disease, or who have had a recent heart attack or stroke. Clopidogrel is also used in combination with aspirin to treat new or worsening chest pain and to keep blood vessels open and prevent blood clots after procedures such as cardiac stenting.

WebMD explains that clopidogrel works by blocking platelets from sticking together and prevents them from forming harmful clots. It is an antiplatelet drug that helps keep blood flowing smoothly in the body

Clopidogrel-induced hepatitis should be suspected in patients who present with abnormal liver enzymes within months of beginning to take the drug. The authors of the case report conclude that “prompt recognition and discontinuation of the offending agent are necessary, as progressive liver injury and even death can occur,” according to MPR.