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Drug Induced Platelet Dysfunction

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Drug Induced Platelet Dysfunction, Drug Induced Platelet Destruction, Drug induced Thrombocytopenia, Drug-Induced Thrombocytopenia, Thrombocytopenia caused by Medications

  1. Chemotherapeutic agents
    1. Alkylating Agents
    2. Antimetabolites
    3. Interferon
    4. Fludarabine
    5. Oxaliplatin
  2. Antibiotics
    1. Sulfonamides (e.g. Bactrim)
    2. Penicillins
    3. Cephalosporins
    4. Rifampin
    5. Vancomycin
    6. Fluoroquinolones
    7. Linezolid
    8. Ganciclovir
  3. Cardiovascular Agents
    1. Abciximab (ReoPro)
    2. Eptifibatide (Integrilin)
    3. Tirofiban
    4. Digoxin
    5. Methyldopa
    6. Procainamide
    7. Cinchona alkaloids (Quinidine, Quinine, Tonic Water)
    8. Thiazide Diuretics (Hydrochlorothiazide, Chlorthalidone)
  4. H2 Antagonists
    1. Cimetidine (Tagamet)
    2. Ranitidine (Zantac)
  5. Neuropsychiatric agents
    1. Barbiturates
    2. Phenytoin (Dilantin)
    3. Valproic Acid (Depakene)
    4. Carbamazepine (Tegretol)
  6. Miscellanous Agents
    1. Chronic Alcohol Abuse
    2. Estrogens
    3. Gold Salts
    4. MMR Vaccine
    5. Sulfasalazine (Azulfidine)
    6. Propylthiouracil
    7. Heparin Induced Thrombocytopenia
      1. Occur in 5% of patients on >5 days Heparin
      2. In vivo platelet aggregation due to immune complexes against platelet factor 4 (PF4) and Heparin
  • Causes
  • Platelet impaired function
  1. Common causes
    1. Consider agents that affect coagulation (Heparin, Warfarin)
    2. Aspirin
    3. Nonsteroidal Antiinflammatory Drugs (NSAIDs)
    4. Clopidogrel (Plavix)
  2. Other causes
    1. Antidepressants
      1. Tricyclic Antidepressants
      2. Selective Serotonin Reuptake Inhibitors
    2. Antihistamines
      1. Azatadine
      2. Brompheniramine
      3. Clemastine fumarate
    3. Clofibrate
    4. Dipyridamole
    5. Furosemide (Lasix)
    6. Ginkgo Biloba
    7. Nitrofurantoin (Furadantin)
    8. Propranolol
    9. Sulfinpyrazone
  • Management
  1. Discontinue offending agent and recheck Platelet Count in 1 week
  2. See Thrombocytopenia
  3. See Thrombocytopenia Causes
  • Course
  1. Onset within 5 to 7 days of starting the medication
  2. Expect recovery in 7-14 days after discontinuation of medication
  • References
  1. Merrill and Gillen (2016) Crit Dec Emerg Med 30(3): 3-8
  2. Kenney (2009) Arch Pathol Lab Med 133(2): 309-14 [PubMed]