title: Severe thrombocytopenia following intraarterial papaverine administration for treatment of vasospasm.
abstract: Selective intraarterial infusion of papaverine is used in the treatment of symptomatic cerebral vasospasm. The authors report two episodes of severe thrombocytopenia in a patient that were related to intraarterial administration of papaverine. A 70-year-old man with a right internal carotid artery aneurysm underwent craniotomy and aneurysm clipping. He became lethargic 8 days after the hemorrhage occurred. Cerebral angiography revealed moderate vasospasm. In addition to hypervolemic-hypertensive therapy, the patient was treated on two occasions with intraarterial administration of papaverine. Within 24 hours of both treatments he developed severe thrombocytopenia. On one occasion epistaxis requiring transfusion of blood products occurred. Laboratory data support the diagnosis of immune-mediated papaverine-induced thrombocytopenia. The authors conclude that intraarterial administration of papaverine for treatment of vasospasm can be associated with severe, rapidly reversible thrombocytopenia.
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Miller
authors.forename: D T
authors.initials: DT
authors.lastname: Cross
authors.forename: C J
authors.initials: CJ
authors.lastname: Moran
authors.forename: R G
authors.initials: RG
authors.lastname: Dacey
authors.forename: J G
authors.initials: JG
authors.lastname: McFarland
authors.forename: M N
authors.initials: MN
authors.lastname: Diringer
mesh_terms: D000368:Aged; D000906:Antibodies / Q000032:analysis; D001792:Blood Platelets / Q000276:immunology; D002533:Cerebral Angiography; D006801:Humans; D007261:Infusions, Intra-Arterial; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D010208:Papaverine / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology
chemical_list: D000906:Antibodies; D010208:Papaverine