* (sooner if previously sensitized with drug exposure)  **(drugs with longer half-lives may have delayed recovery)
One of the most common indications of amiodarone is atrial fibrillation and this diagnosis requires anticoagulation for thromboembolic stroke prevention16,17. If a patient develops severe amiodarone induced thrombocytopenia in this setting, anticoagulation may require interruption for several days due to the long half-life of amiodarone. This can increase the risk of thromboembolic stroke with serious clinical consequences.
The role of both high dose steroids and IVIG in the management of DITP has not been well established unlike immune thrombocytopenia (ITP) where both these drugs have a long track record of efficacy18. High dose steroids can have serious side effects including hypertension, poor glycemic control, gastric ulceration (thrombocytopenia compounds bleeding risk), edema, encephalopathy (especially intravenous administration in elderly patients), anxiety, restlessness, insomnia which contribute to patient morbidity and rarely mortality during hospitalization. IVIG therapy, other than being expensive, carries risk of serious allergic reactions. However, we believe that if there is a strong clinical suspicion of DITP and it is perceived that the patient is at risk of life-threatening hemorrhage from severe DITP despite discontinuation of the offending drug then a trial of corticosteroids/IVIG can be justified. Platelet transfusion carries risk of infection, allergic reaction, alloimmunization, fluid overload and hence its judicious use is advised. Platelet transfusion is recommended in case of active bleeding with a platelet count under 50,00019.
Conclusion
DITP can present as an acute or delayed-onset complication of amiodarone. Given its frequent use in clinical practice, it is crucial to diagnose this entity in a timely manner in order to prevent hemorrhagic complications.
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