Decreased availability of ADP prevents glycoprotein IIb/IIIa expression on platelets leading to an inability of platelet aggregation by inhibiting fibrinogen from binding.
Ticlopidine (Ticlid) works by inhibiting platelet aggregation. Because the effects are irreversible, the antiplatelet action will continue until death or destruction of the platelet occurs.
Because a clump of platelets makes up the center of a thrombus or clot, use of ticlopidine to inhibit platelet aggregation will ultimately work to prevent a thrombotic event. It is important to note; however, that this medication should only be used for patients who have not responded to aspirin therapy, or those who cannot tolerate the use of aspirin.
Neutropenia, a low neutrophil or white blood cell count, may occur with ticlopidine therapy. This condition can increase a patient’s risk of infection; however, it is not permanent. White blood cell counts will return to normal one to three weeks after stopping the medication.
TTP is a disorder of the coagulation system that causes small clot formation throughout the body. Patients with TTP may exhibit fever and changes in neurologic function. Lab results may also reveal low platelet counts, anemia, and kidney problems.
Patients taking ticlopidine may experience GI distress including diarrhea, abdominal pain, gas, nausea, and dyspepsia (heartburn).
Skin reactions such as a rash, itching, or purpura may occur while taking ticlopidine. Purpura will manifest as small, purple discolorations of the skin.
Ticlopidine (Ticlid) should be withheld before surgery, due to increased risk of bleeding. Keep in mind that the effects of the drug remain in the body for 7 to 10 days after the last dose, so ample time must be planned for the discontinuation of the drug prior to surgery.
Patients taking ticlopidine (Ticlid) should have their complete blood count (CBC) monitored every two weeks for the first 3 months of drug therapy. If neutropenia, TTP, or agranulocytosis occurs, ticlopidine therapy should be stopped immediately.
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