Clopidogrel induced interstitial lung disease is a rare serious complication https://youtu.be/05IHSSHIRZI?si=qA2EPQRawD0BQ_XG

1. Clopidogrel-Associated
Interstitial Lung Disease
By
Dr Mohammud Ibraheem

2. P2Y12 Receptor Antagonists
Thienopyridines:
1) Ticlopidine,
2) Clopidogrel,
3) Prasugrel
They are prodrugs.
They inhibit ADP-mediated platelet
aggregation by irreversibly blocking
purinergic P2Y12 receptors on the platelets

3. P2Y12 Receptor Antagonists
Non thienopyridine drugs:
1. Ticagrelor
2. Cangrelor
3. Elinogrelor
They don't need metabolic activation
They inhibit ADP-mediated platelet
aggregation by reversibly blocking
purinergic P2Y12 receptors on the platelets

4. Common AE of thienopyridines
I. Thrombotic thrombocytopenic purpura
II. Hemorrhage,
III. Typical allergic reactions include pruritic
macular, erythematous, confluent rash
starting on the trunk or face,
angioedema, and anaphylaxis.

5. Clopidogrel induced ILD
Pulmonary complications caused by
clopidogrel are not widely described, and
clopidogrel-induced interstitial lung disease
(ILD) is rare.
Pulmonary complications of antiplatelet
agents include alveolar hemorrhage and
ILDs as organizing pneumonia or
eosinophilic pneumonia

6. Pathophysiology
The pathophysiology is not well understood.
It seems that allergic reactions and
neutrophil activation may lead to lung
scarring and fibrosis instead of direct toxicity
from the drugs or chemicals.
Additionally, clopidogrel activate neutrophils
and macrophages, leading to fibrosis and
scarring.

7. ILD
ILD is an umbrella term used for a large
group of disorders that cause lung scarring
or fibrosis. Lung scarring causes stiffness in
the lungs resulting in breathing difficulty.
Lung injury from ILD is often irreversible and
worsens over time.
Prevalence of ILD is 20%, it is higher in men
than in women.
2.5-3% of ILD is induced by drugs.

8. Etiology of ILD
A. ILD can be idiopathic (the most common).
B. Other etiologies
1. Autoimmune disease,
2. Chemotherapy,
3. Radiation,
4. Drugs, Antitumor drugs are the leading cause of
ILD (23-52%), followed by antirheumatic drugs,
antibiotics, and antidysrhythmic drugs
5. Environmental and occupational exposure.

9. Clinical presentation
1. Shortness of breath, tachycardia,
2. Mild fever,
3. Bilateral chest pain, widely distributed
pulmonary rales bilaterally
4. Anorexia,
5. Nausea

10. High resolution CT
1. HRCT ruled out :
A. Pulmonary embolism
B. Typical AE associated with clopidogrel like
pulmonary interstitial hemorrhage.
2. HRCT show:
A. Localized fluid collection
B. Bilateral ground-glass appearance of the
lungs
C. Pleural effusions
D. Pericardial effusion.

11. High-resolution CT chest
a) diffuse crazy-paving and consolidation
bilaterally
b) focal parenchymal band in both lungs.

12. HRCT sagittal
view of left lung
It showe
intralobular
septal
thickening with
ground glass
opacities
consistent with
pulmonary
edema.

13. TREATMENT
ILD can lead to a series of life-threatening
complications, including pulmonary
hypertension, right-sided heart failure,
respiratory failure, and secondary infections.
A. STOPE clopidogrel
B. corticosteroids

14. THANK YOU