A Systematic Retrospective Study and Review of Vancomycin Induced Thrombocytopenia
ZHANG Jin-hong1, FANG De-min1*, GAO Ying1, DAI Bin1, LIU Zhi-yong2, HOU Wei1
1.Pharmaceutical Department of Tianjin Hospital, Tianjin 300211, China; 2. Sugical Intensive Care Unitersity of Tianjin Hospital, Tianjin 300211, China)
Abstract��OBJECTIVE To review and analyze the clinical characteristics of thrombocytopenia induced by vancomycin. METHODS Databases of PUBMED��EMBASE��CBM��CNKI��VIP and WANFANG data (from built to January 2017) were conducted for case reports published in English or Chinese involving thrombocytopenia induced by vancomycin. Literatures were screened, extracted and statistics analysis by two authors independently. RESULTS A total of 2 428 literatures were searched out and 36 were included involving 37 patients. 70.3% of the patients were male, median age was 55.0 years, most of them had underlying diseases and combined with a variety of drugs, 62.2% of which combined with other antimicrobial agents.The clinical manifestation of ADR was thrombocytopenia or complete blood loss associated with or without bleeding symptoms, 45.9% patients were attacted by severe bleeding.The median time of thrombocytopenia for the first and second time was 7.0 d and 24.0 h, the median cumulative dosage was 8.0 g and 3.5 g, the median platelet counts was 23.0��109L-1 and 77.0��109L-1, respectively. The median time to platelet nadir counts for the first and second time was 9.0 d and 24.0 h, the median cumulative dosage was 16.0 g and 3.5 g, the median platelet counts was 10.0��109L-1 and 58.0��109L-1, respectively. The median time returned to normal platelet counts for the first and second time was 5.0 d and 4.5 d, respectively.For the third time, a single dose of vancomycin was administered and thrombocytopenia developed within 12 h with a nadir platelet counts of 11.0��109L-1, the platelet counts restored to normal within 7.0 d. Platelet counts returned to normal in 94.6% of patients after vancomycin was discontinued and/or took other measures, three of them died from various reasons but not the ADR of vancomycin. Vancomycin-dependent antibodies were detected in 59.5% of patients. The correlation evaluation of ADR was definite, probable, and possible in 4, 23, and 10 patients, respectively.CONCLUSION High attention should be put on thrombocytopenia induced by vancomycin, male patients with middle or old age, underlying diseases, renal insufficiency and exposure to drugs were the risk factors of thrombocytopenia .Platelet counts should be closely monitored during the use of vancomycin. Testing for drug-dependent antibodies can be helpful for identifying the cause of thrombocytopenia in patients who were receiving vancomycin. More data is need to confirm the incidence and severity of thrombocytopenia induced by vancomycin.
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