Drug-induced cholestasis: case report

Clopidogrel is an effective anti-platelet drug that is commonly prescribed for patients with atherosclerotic coronary and peripheral vascular diseases, especially after angioplasty and coronary artery bypass graft surgery. Even though this drug seems safe, there are case reports of important side effects with its use.

The patient was 67 years old male admitted with a diagnosis of inferior myocardial infarction who underwent angioplasty on RCA with a drug-eluting stent and was discharged with an uneventful course from hospital with medical treatment, including Clopidogrel. The patient came back to the clinic 30 days later with icter, nausea and loss of appetite. The lab data showed: Bilirubin (total= 5, direct=4), ALT=220, AST=100, Gama GT=830, Alk.phop=445. Virologic and imaging studies were normal. With a possible diagnosis of drug-induced hepatic injury all possible Prescribed drugs were held stepwise but bilirubin and the patient’s symptoms did not relieve until Clopidogrel has been changed. After 10 days bilirubin and his symptom relieved.

Clopidogrel is a common and partially safe drug, but it may cause hepatic injury. Considering Clopidogrel side effects and its interactions seem necessary for patient management.