From the Guidelines
Medications that can cause thrombocytopenia include heparin, quinine, sulfonamide antibiotics, vancomycin, valproic acid, carbamazepine, and many chemotherapy drugs, which can trigger an immune response or directly suppress platelet production in the bone marrow. These medications can lead to low platelet counts through various mechanisms, and the onset of thrombocytopenia can vary from days to weeks after starting the medication 1.
Key Medications to be Aware of:
- Heparin (anticoagulant)
- Quinine (used for malaria and leg cramps)
- Sulfonamide antibiotics (e.g., sulfamethoxazole)
- Vancomycin (antibiotic)
- Valproic acid (anticonvulsant)
- Carbamazepine (anticonvulsant)
- Many chemotherapy drugs If you're experiencing unexplained bruising, bleeding, or petechiae (small red or purple spots on the skin) while taking any of these medications, consult your healthcare provider immediately, as they may need to adjust your medication or monitor your platelet counts closely 1.
Important Considerations:
- Never stop taking prescribed medications without medical advice, as the risks of discontinuation may outweigh the benefits in some cases.
- The combination of certain medications, such as aspirin and anticoagulants, can increase the risk of bleeding and thrombocytopenia 1.
- The risk of thrombocytopenia is increased in patients treated with certain medications, such as heparin, and can be associated with significantly increased risk of thrombotic events, MI, major bleeding, and in-hospital mortality 1. It is essential to be aware of these medications and their potential to cause thrombocytopenia, and to consult with a healthcare provider if you have any concerns or are experiencing symptoms while taking these medications.
From the Research
Medications that can Cause Thrombocytopenia
- Heparin: a widely used anticoagulant that can cause heparin-induced thrombocytopenia, a condition characterized by a low platelet count 2, 3
- Nonsteroidal anti-inflammatory drugs: can impair platelet function and cause or aggravate hemorrhages in certain clinical settings 4
- Antibiotics: can interfere with platelet reactivity or induce platelet inhibition 4
- Cardiovascular and lipid-lowering drugs: can impair platelet function and cause or aggravate hemorrhages in certain clinical settings 4
- Selective serotonin reuptake inhibitors: can interfere with platelet reactivity or induce platelet inhibition 4
- Volume expanders: can impair platelet function and cause or aggravate hemorrhages in certain clinical settings 4
- Acetylsalicylic acid (aspirin): a well-known antiplatelet drug that can impair platelet function 4
- Adenosine diphosphate receptor antagonists (clopidogrel and prasugrel): can impair platelet function and cause or aggravate hemorrhages in certain clinical settings 4
- Integrin αIIbβ3 (GPIIb-IIIa) receptor blockers (abciximab, eptifibatide, and tirofiban): can impair platelet function and cause or aggravate hemorrhages in certain clinical settings 4
Specific Medications and their Effects on Platelet Count
- Low-dose heparin: does not appear to cause thrombocytopenia in most patients, but monitoring of platelet count is still recommended 5
- Low-molecular-weight heparin: can cause heparin-induced thrombocytopenia, and monitoring of platelet count is recommended 6
- Unfractionated heparin: can cause heparin-induced thrombocytopenia, and monitoring of platelet count is recommended 2, 3, 6