Introduction Thrombocytopenia occurs in 15% to 58% of intensive care unit patients. Up to 25% of acutely ill patients develop drug-induced thrombocytopenia. Establishing the etiology of secondary thrombocytopenia is challenging, since many medications and co morbidities have been implicated.
Objective To define the incidence and severity of thrombocytopenia in critically ill patients and to examine risk factors that may be related to the development of thrombocytopenia.
Method This is a retrospective chart review of 328 critically ill patients with thrombocytopenia requiring at least 72 hours of critical care. 30 suspected risk factors, including patient characteristics, drug effects, and associated diseases were identified from the literature and further evaluated using a multiple logistic regression. Mild Thrombocytopenia defined as platelet count less than 200 x 10(9)/L was observed frequently, but only 9 percent had severe thrombocytopenia defined as less than 20 x 10(9)/L.
Results Demographic characteristics of patients predisposed to thrombocytopenia are males, older than 55, and Hispanic population. Hemodynamic instability and/or heparin exposure appear to be the strongest identifiable correlates with thrombocytopenia. Sepsis, acute kidney injury and respiratory failure were strongly correlated (p<0.0001) with thrombocytopenia. Patients with severe thrombocytopenia were found to have concurrent alterations in liver function tests. Patients with central line placement and heparin exposure were associated strongly with mild thrombocytopenia (p<0.0001). Drug therapies that were correlated with thrombocytopenia included Heparin, Protonix, Lasix, Ativan and Zofran and antibiotics such as Vancomycin, Cephalosporins and Levaquin.
Conclusion Drug regimens should be evaluated daily for minimization of adverse drug events including thrombocytopenia. Once the diagnosis is suspected, clinicians should identify the medication and/or risk factors causing secondary thrombocytopenia to assess the timeline of development. Co morbidity associated with thrombocytopenia was sepsis syndrome, liver disorder, alcoholism and atrial fibrillation. Medications commonly associated with drug-induced thrombocytopenia include glycoprotein IIb/IIIa inhibitors, cinchona alkaloids, antibiotics, anticonvulsants, and heparin. Thrombocytopenia generally resolved in most patients with critical management of the disease and discontinuation of the offending medication.
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