Prevention of Ischemic Stroke

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Abstract
Barnett et al. (Jan. 26 issue)1 state that “neutropenia occurs early but is reversible after the cessation of [ticlopidine].” Unfortunately, this is not always true. Six patients who died of irreversible ticlopidine-induced bone marrow failure have been reported to the Canadian Health Protection Branch. In four of the patients (one man and three women; age, 70 to 86 years), agranulocytosis developed (granulocyte count, <500 per cubic millimeter) 15 to 74 days (mean, 38) after ticlopidine was begun. Two women, 72 and 84 years old, had aplastic anemia that first presented as agranulocytosis 27 and 41 days after ticlopidine was begun.