Acute hematuria due to low loading dose of clopidogrel combined with aspirin

Abstract

A 72-year-old male patient who had undergone percutaneous coronary intervention (PCI) twice previously was admitted to the First Affiliated Hospital of Soochow University because of relapsing coronary artery stenosis and scheduled to undergo PCI again. Previously, he was given a routine dose of dual antiplatelet therapy (clopidogrel 75 mg/d and aspirin 100 mg/d) orally after the two PCI without any obvious adverse reactions. On the day of admission, the patient received a low loading dose of clopidogrel (300 mg) and aspirin (100 mg) orally, and then developed acute visible hematuria in about 2 hours after the medication. The ultrasonography revealed blood clots in his bladder and routine urine test revealed red blood cells 58 686 per microlitre. On day 2 of admission, not aspirin but clopidogrel was discontinued. On day 5 of admission, his urine color and ultrasound imaging of the urinary system returned to normal. On day 8, his routine urine test showed normal and clopidogrel 50 mg/d was given. On day 15, the dose of clopidogrel was increased to 75 mg/d. On day 19, the patient received PCI, implanting a drug-eluting stent in the left anterior descending coronary artery, and dual antiplatelet therapy was given at routine dose after the operation. On day 3 of postoperation, the patient recovered well and was discharged from hospital. After 1 month of follow-up, hematuria did not recur. Key words: Platelet aggregation inhibitors; Aspirin; Hematuria; Clopidogrel