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Drug-induced thrombocytopenia: pathogenesis, evaluation, and management George JN; Aster RHHematology Am Soc Hematol Educ Program 2009[]; ä (ä): 153-8Although 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.|Adult[MESH]|Adverse Drug Reaction Reporting Systems[MESH]|Antibody Specificity[MESH]|Antigens, Human Platelet/drug effects/immunology[MESH]|Autoantibodies/*immunology[MESH]|Beverages/adverse effects[MESH]|Case-Control Studies[MESH]|Child[MESH]|Databases, Factual[MESH]|Diagnosis, Differential[MESH]|Drug-Related Side Effects and Adverse Reactions[MESH]|Epitopes/drug effects/immunology[MESH]|Fibrinolytic Agents/adverse effects[MESH]|Food/adverse effects[MESH]|Humans[MESH]|Immunologic Memory[MESH]|Immunosuppressive Agents/therapeutic use[MESH]|Platelet Transfusion[MESH]|Purpura, Thrombocytopenic, Idiopathic/diagnosis[MESH]|Thrombocytopenia/*chemically induced/diagnosis/drug therapy/therapy[MESH] |
