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Case Reports in Emergency Medicine
Volume 2018, Article ID 3786504, 3 pages
https://doi.org/10.1155/2018/3786504
Case Report

Ticagrelor as an Alternative for Clopidogrel-Associated Acute Arthritis

1Pharmacy Department, University of Missouri Health System, One Hospital Drive DC060.00, Columbia, MO 65212, USA
2Department of Emergency Medicine, University of Missouri, M562, One Hospital Drive DC029.1, Columbia, MO 65212, USA
3Division of Cardiovascular Medicine, University of Missouri, One Hospital Drive, CE 306, Columbia, MO 65212, USA

Correspondence should be addressed to Starr-Mar’ee C. Bedy; ude.iruossim.htlaeh@sydeb

Received 18 December 2017; Accepted 26 February 2018; Published 8 April 2018

Academic Editor: Serdar Kula

Copyright © 2018 Starr-Mar’ee C. Bedy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 65-year-old Caucasian man was hospitalized for a non-ST-elevation myocardial infarction. On discharge, the patient was started on multiple new medications, including clopidogrel and atorvastatin. Twenty-six days after discharge, he presented to the Emergency Department (ED) with polyarthralgias. He was instructed to stop atorvastatin and to follow up with rheumatology and cardiology clinic. At cardiology clinic follow-up 43 days after ED discharge, clopidogrel was discontinued and patient was switched to ticagrelor. On follow-up one month later, his symptoms had completely resolved. During the next 4 months, patient had routine follow-up due to participation in Cardiopulmonary Rehab and he had no cardiac events or recurrence of joint symptoms. Our patient had no history of arthritis. Because he initially presented with 2 medication classes associated with arthritis, each was withdrawn separately. The temporal association of patient’s symptomatic improvement strongly suggests that the arthritis was caused by clopidogrel. Our patient was able to tolerate ticagrelor with complete resolution of his arthritis and no cardiac events. Clopidogrel-induced arthritis is a rare adverse drug event. For patients with a recent drug-eluting stent, alternative antiplatelet therapy with ticagrelor may provide positive cardiac outcomes without similar adverse effects.