Drug-Induced Thrombocytopenic Purpura: A Systematic Review and Meta-analysis of Case Reports

Abstract

In the present systematic review and meta-analysis, the authors analysed case reports of drug-induced thrombocytopenia/drug-induced thrombocytopenic purpura (DITP) and its mechanisms. The search included electronic databases for case reports of DITP using specific keywords in MEDLINE via PubMed, PubMed Central, and Embase. All case reports were designated a score/criteria (definite, probable, or possible). The mechanism of DITP was also analysed in each case report. A total of 751 case reports were included in the meta-analysis. The incidences for all-score DITP by random and common effect models were 0.65% (95% confidence interval: 0.61–0.69) and, 0.65% (95% confidence interval: 0.62–0.68), respectively. The number of DITPs with scores of 1, 2, and 3 was found in 151, 300, and 300 patients, respectively. Amongst the drugs, the maximum number of DITPs were caused by antibiotics, antimalarials, monoclonal antibodies, antiplatelet drugs, disease-modifying antirheumatic drugs, anti-epileptics, anti-cancer chemotherapeutics, and non-steroidal anti-inflammatory drugs. Out of 751 cases, 478 patients were hospitalised, and 323 patients had external or internal bleeding, including 62 patients who had major bleeding intracranially or retroperitoneally and required transfusion of two or more units of red blood cells. Mortality occurred in 12 patients. Clinicians should be aware of the potential of drugs causing DITP as an important adverse event, as it may affect patient compliance and adherence to drugs. Unrecognised DITP may lead to severe thrombocytopenia and inappropriate patient management.