臨床上除了heparin之外，會引起thrombocytopenia的藥，ICU要小心…


Drug-Induced Immune Thrombocytopenia

Two dozen drugs are associated with DITP.

Patients who take medication often experience low platelet counts. When this occurs, the task for the clinician is to determine whether the thrombocytopenia is disease-related or drug-related. Certain medications can either decrease platelet production or induce antibodies that act against platelet-membrane glycoproteins and, thereby, cause platelet destruction. The latter mechanism is relatively uncommon, but discontinuing a drug that is having this effect might prevent a serious or fatal hemorrhage.

An international team of investigators used three sources to identify drugs suspected of inducing thrombocytopenia: case reports of drug-induced immune thrombocytopenia (DITP) published during more than 10 years, adverse drug events reported to the FDA, and data from 14 years of laboratory testing for drug-dependent binding of antibodies to platelets performed at the BloodCenter of Wisconsin.

Of 1468 drugs suspected of causing thrombocytopenia, 102 were identified in at least one of the three sources. Of these, 23 showed causal associations with DITP in all three sources; one other (amiodarone) was identified in two sources (case reports and laboratory testing). The table lists the 24 implicated drugs by therapeutic category.

Comment: The drug most frequently implicated in DITP is heparin. However, in contrast to the agents identified in this study, heparin usually does not induce severe thrombocytopenia, and the main clinical effect of heparin-induced thrombocytopenia is thrombosis rather than bleeding. After heparin is excluded as a cause of DITP, all other drugs that the patient is receiving become suspect. Those listed in the table have proven associations with DITP. If one of these agents is being given to a patient with thrombocytopenia, it should be withheld, and the patient's serum should be sent to a reference laboratory for drug-dependent antibody testing.

— David Green, MD, PhD

Published in Journal Watch Oncology and Hematology November 9, 2010

Citation(s):

Reese JA et al. Identifying drugs that cause acute thrombocytopenia: An analysis using 3 distinct methods. Blood 2010 Sep 23; 116:2127.

Warkentin TE and Anderson JAM. DITP causation: 3 methods better than 1? Blood 2010 Sep 23; 116:2002.

記好這個表就可以了……

https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7MjhjY2U1MjUtNTM2NS00NTA3LWEwYzMtYjA2MmQxNjY0ZWJj&hl=zh_TW

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