Meropenem and Thrombocytopenia in Critically Ill Patients
Yes, meropenem can cause thrombocytopenia, particularly in patients with renal impairment, though no clinical bleeding has been reported in clinical trials. 1
FDA-Labeled Warning
The FDA label explicitly warns that thrombocytopenia has been observed in patients with renal impairment receiving meropenem, though importantly, no clinical bleeding was reported in these cases. 1 This is listed as a specific warning requiring monitoring in the official prescribing information. 1
Clinical Trial Evidence
Incidence and Characteristics
In clinical trials of 2,904 adult patients treated with meropenem, decreased platelets were reported as an adverse laboratory change occurring in greater than 0.2% of patients. 1
A comprehensive safety review of nearly 5,000 patients found that thrombocytosis (increased platelets) was actually more common (1.6%) than thrombocytopenia with meropenem use. 2
The most common meropenem-related adverse events were diarrhea (2.3%), rash (1.4%), and nausea/vomiting (1.4%), with thrombocytopenia being less frequently reported. 2
Risk Factors
The primary risk factor is renal impairment. 1 The FDA label specifically notes that patients with moderately severe renal impairment (creatinine clearance 10 to 26 mL/min) had increased incidence of multiple complications including thrombocytopenia. 1
Comparative Evidence in Critically Ill Patients
A 2013 randomized controlled trial in critically ill patients provides important context: 3
High exposure to broad-spectrum antimicrobials, including meropenem, did not result in increased thrombocytopenia compared to standard-of-care antimicrobial regimens. 3
In observational analyses from this trial, ciprofloxacin and piperacillin/tazobactam were associated with thrombocytopenia risk, but meropenem was not specifically implicated as a major contributor. 3
Thrombocytopenia (absolute or relative) was common in critically ill patients (35% developed absolute thrombocytopenia during ICU stay), but this was related to critical illness rather than specific antimicrobials. 3
Mechanism: Immune-Mediated Thrombocytopenia
A 2017 case report documented meropenem-induced immune thrombocytopenia (DITP) confirmed by laboratory testing: 4
The patient developed severe thrombocytopenia 8 days after meropenem administration. 4
Laboratory testing demonstrated that platelet antibodies were detected only in the presence of meropenem, with glycoprotein IIb/IIIa identified as the binding site. 4
This represents a drug-dependent antibody mechanism, similar to other drug-induced immune cytopenias. 4
Clinical Implications and Monitoring
When to Suspect Meropenem-Induced Thrombocytopenia
Acute thrombocytopenia developing during meropenem treatment, particularly 5-10 days after initiation. 4
Presence of renal impairment (creatinine clearance 10-26 mL/min or lower). 1
Exclusion of other common causes in critically ill patients: sepsis-related consumption, heparin-induced thrombocytopenia, disseminated intravascular coagulation. 5
Monitoring Recommendations
While not specific to meropenem, guidelines for critically ill patients recommend: 5
Monitor platelet count every 24-72 hours in the acute phase of critical illness. 5
This monitoring helps detect multiple potential causes of thrombocytopenia, including drug-induced cases. 5
Common Pitfalls
Do not assume all thrombocytopenia in critically ill patients is drug-related. Sepsis, DIC, and heparin-induced thrombocytopenia are more common causes. 5
Meropenem-induced thrombocytopenia is rare compared to its overall favorable safety profile in nearly 5,000 patients studied. 2
The absence of clinical bleeding in FDA-documented cases suggests the thrombocytopenia is typically mild to moderate. 1
Renal dose adjustment is critical to minimize risk, as accumulation in renal impairment increases adverse event risk. 1