* (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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