» Articles » PMID: 35642486

Treatment of Drug-induced Immune Thrombocytopenias

Overview
Journal Haematologica
Specialty Hematology
Date 2022 Jun 1
PMID 35642486
Authors
Affiliations
Soon will be listed here.
Abstract

Several therapeutic agents can cause thrombocytopenia by either immune-mediated or non-immune-mediated mechanisms. Non-immune-mediated thrombocytopenia is due to direct toxicity of drug molecules to platelets or megakaryocytes. Immune-mediated thrombocytopenia, on the other hand, involves the formation of antibodies that react to platelet-specific glycoprotein complexes, as in classic drug-induced immune thrombocytopenia (DITP), or to platelet factor 4, as in heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombotic thrombocytopenia (VITT). Clinical signs include a rapid drop in platelet count, bleeding or thrombosis. Since the patient's condition can deteriorate rapidly, prompt diagnosis and management are critical. However, the necessary diagnostic tests are only available in specialized laboratories. Therefore, the most demanding step in treatment is to identify the agent responsible for thrombocytopenia, which often proves difficult because many patients are taking multiple medications and have comorbidities that can themselves also cause thrombocytopenia. While DITP is commonly associated with an increased risk of bleeding, HIT and VITT have a high mortality rate due to the high incidence of thromboembolic complications. A structured approach to drug-associated thrombocytopenia/thrombosis can lead to successful treatment and a lower mortality rate. In addition to describing the treatment of DITP, HIT, VITT, and vaccine-associated immune thrombocytopenia, this review also provides the pathophysiological and clinical information necessary for correct patient management.

Citing Articles

Asymptomatic thrombocytopenia after nintedanib initiation in a patient with progressive pulmonary fibrosis: a case report and review of literature.

Zhang X, Zhang K, Zhao N, Xi N, Zhao T J Med Case Rep. 2024; 18(1):451.

PMID: 39342394 PMC: 11439192. DOI: 10.1186/s13256-024-04790-y.


Subsequent Vaccination against SARS-CoV-2 after Vaccine-Induced Immune Thrombotic Thrombocytopenia.

Uzun G, Ringelmann T, Hammer S, Zlamal J, Luz B, Wolf M J Clin Med. 2024; 13(18).

PMID: 39336949 PMC: 11431967. DOI: 10.3390/jcm13185462.


Rifabutin-Induced Thrombocytopenia in a Patient With Uncontrolled HIV: A Case Report.

Tamr A, Kabbani D, Weinberger J Cureus. 2024; 16(8):e66339.

PMID: 39247045 PMC: 11377851. DOI: 10.7759/cureus.66339.


The Phenomenon of Thrombotic Microangiopathy in Cancer Patients.

Vorobev A, Bitsadze V, Yagubova F, Khizroeva J, Solopova A, Tretyakova M Int J Mol Sci. 2024; 25(16).

PMID: 39201740 PMC: 11354439. DOI: 10.3390/ijms25169055.


Association of thrombocytopenia with immune checkpoint inhibitors: a large-scale pharmacovigilance analysis based on the data from FDA adverse event reporting system database.

Liu G, Zhang S, Mo Z, Huang T, Yu Q, Lu X Front Pharmacol. 2024; 15:1407894.

PMID: 38953101 PMC: 11215080. DOI: 10.3389/fphar.2024.1407894.


References
1.
Xiao Z, Visentin G, Dayananda K, Neelamegham S . Immune complexes formed following the binding of anti-platelet factor 4 (CXCL4) antibodies to CXCL4 stimulate human neutrophil activation and cell adhesion. Blood. 2008; 112(4):1091-100. PMC: 2515144. DOI: 10.1182/blood-2008-04-153288. View

2.
Lo G, Juhl D, Warkentin T, Sigouin C, Eichler P, Greinacher A . Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006; 4(4):759-65. DOI: 10.1111/j.1538-7836.2006.01787.x. View

3.
Nagler M, Fabbro T, Wuillemin W . Prospective evaluation of the interobserver reliability of the 4Ts score in patients with suspected heparin-induced thrombocytopenia. J Thromb Haemost. 2011; 10(1):151-2. DOI: 10.1111/j.1538-7836.2011.04552.x. View

4.
Uzun G, Althaus K, Bakchoul T . No Correlation between Anti-PF4 and Anti-SARS-CoV-2 Antibodies after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021; 385(14):1334-1336. PMC: 8427534. DOI: 10.1056/NEJMc2111305. View

5.
Warkentin T, Davidson B, Buller H, Gallus A, Gent M, Lensing A . Prevalence and risk of preexisting heparin-induced thrombocytopenia antibodies in patients with acute VTE. Chest. 2011; 140(2):366-373. DOI: 10.1378/chest.10-1599. View