Zusammenfassung
Ein 71-jähriger Patient mit bekanntem chronischem
Vorhofflimmern stand bei einem Zustand nach rechtszerebralem Insult mit
sekundärer Einblutung unter einer Aspirintherapie. Sechs Jahre später
war eine linkshirnige transitorisch ischämische Attacke aufgetreten. Wegen
der stattgehabten zerebralen Blutung wurde keine orale Antikoagulierung
eingeleitet, sondern Aspirin durch Ticlopidin ersetzt. 40 Tage später
erfolgte die stationäre Aufnahme in unsere Abteilung aufgrund von
abdominellen Beschwerden und eines schmerzlosen Ikterus. Anamnestisch
war es nach 14-tägiger Einnahme von Ticlopidin zu Durchfällen,
zu lehmfarbenem Stuhl und zur Verfärbung des Urins gekommen, weswegen
Ticlopidin vom Patienten abgesetzt wurde. Laborchemisch waren die
Cholestaseparameter deutlich erhöht (γ-GT 143 U/l, alk.
Phosphatase 305 U/l, Bilirubin gesamt 18,6 mg/dl), die Transaminasen
waren um das 2,7fache vermehrt. Bei unauffälliger Oberbauchsonographie
erfolgte nach Ausschluss eines Virusinfektes und normalen immunologischen
Parametern die Leberbiopsie (Bild der ausgeprägten
zentroazinären Cholestase), durch die der Verdacht einer
medikamentös toxischen Ursache erhärtet werden konnte. 79 Tage nach
Absetzen von Ticlopidin lagen die laborchemischen Parameter wieder im
Normbereich.
Nachdem es in den letzten Jahren zu einer deutlichen Zunahme der
Verschreibung von Ticlopidin im Rahmen der Prävention von arteriellen
Thrombosen gekommen ist, ist auch mit einem häufigeren Auftreten von
Nebenwirkungen zu rechnen. Patienten, bei denen eine Dauertherapie geplant ist,
sollten in den ersten 3 Monaten regelmäßig klinisch und
laborchemisch nachbeobachtet werden, um auch seltene Nebenwirkungen wie die
cholestatische Hepatitis rechtzeitig erkennen zu können.
(Cholestatic hepatitis due to a therapy with ticlopidine)
A 71-year-old man with chronic atrial fibrillation was treated with
aspirin because of a right cerebral infarction. Oral anticoagulation was not
initiated because of a secondary hemorrhagic transformation. Six years later
after a left cerebral transient ischemic attack aspirin was replaced by
ticlopidine. Two weeks after starting ticlopidine he experienced abdominal
cramps and diarrhea. Also dark urine and gray-colored stools were noticed, so
that the patient stopped taking ticlopidine. 40 days after starting ticlopidine
he was admitted to our hospital because of cholestatic jaundice. Serum alkaline
phosphatase (305 U/l) and γ GT (143 U/l) were elevated, the
total bilirubin was 18,6 mg/dl at peak. GOT and GPT were 2,7 fold
increased. After exclusion of a viral infection and autoimmune disease liver
biopsy was performed, which showed a centroacinar cholestasis compatible
with a drug-induced liver damage. 79 days after discontinuation of the drug
laboratory signs of cholestasis had disappeared.
In patients in whom long-term therapy with ticlopidine is indicated
regularly laboratory tests and clinical examinations should be done to
recognize infrequent side effects such as the cholestatic hepatitis in
time.
Schlüsselwörter
Cholestatische Hepatitis - Ticlopidin
Key words
Cholestatic Hepatitis - Ticlopidine
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Anschrift für die Verfasser:
Dr. Robert Berent
Allgemein Öffentliches Krankenhaus der Barmherzigen
Schwestern vom Heiligen Kreuz
Grieskirchnerstraße 42
4600 Wels
Österreich
Fax: +43/72 42/4 15-39 86
