Drug-induced thrombocytopenia: pathogenesis, evaluation, and management.
Although drugs are a common cause of acute immune-mediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Most cases of drug-induced thrombocytopenia (DITP) are caused by drug-dependent antibodies that are specific for the drug structure and bind tightly to platelets by their Fab regions but only in the presence of the drug. A comprehensive database of 1301 published reports describing 317 drugs, available at www.ouhsc.edu/platelets, provides information on the level of evidence for a causal relation to thrombocytopenia. Typically, DITP occurs 1 to 2 weeks after beginning a new drug or suddenly after a single dose when a drug has previously been taken intermittently. However, severe thrombocytopenia can occur immediately after the first administration of antithrombotic agents that block fibrinogen binding to platelet GP IIb-IIIa, such as abciximab, tirofiban, and eptifibatide. Recovery from DITP usually begins within 1 to 2 days of stopping the drug and is typically complete within a week. Drug-dependent antibodies can persist for many years; therefore, it is important that the drug etiology be confirmed and the drug be avoided thereafter.
George
James N
JN
Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. james-george@ouhsc.edu
Aster
Richard H
RH
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000918:Antibody Specificity; D016824:Antigens, Human Platelet / Q000187:drug effects / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology*; D001628:Beverages / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D016208:Databases, Factual; D003937:Diagnosis, Differential; D064420:Drug-Related Side Effects and Adverse Reactions; D000939:Epitopes / Q000187:drug effects / Q000276:immunology; D005343:Fibrinolytic Agents / Q000009:adverse effects; D005502:Food / Q000009:adverse effects; D006801:Humans; D007156:Immunologic Memory; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017713:Platelet Transfusion; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy
D016824:Antigens, Human Platelet; D001323:Autoantibodies; D000939:Epitopes; D005343:Fibrinolytic Agents; D007166:Immunosuppressive Agents