Uncertainty over efficacy of clopidogrel in hemolytic uremic syndrome

By Piriya Mahendra

Clinical outcomes for children hospitalized with diarrhea-associated hemolytic uremic syndrome (HUS) are comparable between those treated with clopidogrel and those who are not, show study findings.

"We realize that our study does not allow us to conclude that clopidogrel treated patients have improved outcomes compared to those treated with supportive therapy alone," report Leonard Seltz (University of Colorado, USA) and colleagues in Thrombosis Research.

"However, as HUS is a thrombotic disease, the potential benefits of platelet aggregation inhibitors are plausible."

The retrospective chart review of 72 children aged 18 years or younger with diarrhea-associated HUS showed that 88% were treated with platelet aggregation inhibitors (clopidogrel 56%, sulfinpyrazone 19%, dipyridamole 13%).

Compared with patients who were not treated with platelet aggregation inhibitors, those who were treated with clopidogrel more often experienced central nervous system complications (3 vs 22%), red blood cell transfusions (80 vs 78%), and bleeding complications (8 vs 0%). In addition, more of the clopdiogrel patients experienced chronic kidney disease (5 vs 11%) or died (3 vs 0%).

However, none of these associations reached statistical significance.

The median duration of dialysis was 11 days in 13 clopidogrel-treated patients compared with 21 days in five untreated patients (p=0.04).

The median hospital stay was 9 days in clopidogrel patients compared with 19 days in untreated patients, but this difference was nonsignificant.

The authors say that theirs is the first study to report clopidogrel treatment in children hospitalized with diarrhea and HUS. "Clopidogrel treated patients had acute outcomes comparable to patients in which platelet aggregation inhibitors were not used," they remark, adding that "bleeding complications may occur."

However, they conclude: "Unless [randomized controlled trials] show clinical benefit, clopidogrel and other platelet aggregation inhibitors cannot be recommended as a treatment for diarrhea and HUS at this time."

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