Ticlopidine

INTRODUCTION

Indications

Prevention of stroke in patients who have had a completed thrombotic stroke or precursors to stroke and are unable to tolerate aspirin. Unlabeled Use: Prevention of early restenosis in intracoronary stents.

Action

Inhibits platelet aggregation by altering the function of platelet membranes. Prolongs bleeding time. Therapeutic Effects: ↓ incidence of stroke in high-risk patients.

Adverse Reactions/Side Effects

CNS: dizziness, headache, weakness. EENT: epistaxis, tinnitus. GI: diarrhea, abnormal liver function tests, anorexia, GI fullness, GI pain, nausea, vomiting. GU: hematuria. Derm: rashes, ecchymoses, pruritus, urticaria. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, INTRACEREBRAL BLEEDING, NEUTROPENIA, bleeding, thrombocytopenia. Metab: hypercholesterolemia, hypertriglyceridemia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Be especially alert for signs of intracranial bleeds, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, and visual disturbances. Notify physician or nursing staff immediately if these signs occur.

• Watch for signs of neutropenia or agranulocytosis (fever, sore throat, mucosal lesions, other signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to aplastic anemia or other blood dyscrasias. Report these signs to the physician or nursing staff immediately.

• Assess dizziness and weakness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

• Use caution during aerobic exercise in patients with a history of stroke or who are at risk for stroke. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels, neurological signs), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.

• Remind patients to take medication as directed to reduce the risk of stroke even if they are asymptomatic.

• Counsel patients about additional interventions to help reduce the risk of stroke and other cardiovascular pathology, including regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.

• Advise patient that this drug may cause problems in fat metabolism, including increased cholesterol and triglycerides. Remind patient that periodic blood tests may be needed to monitor plasma lipids.

• Instruct patient or family/caregivers ...