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Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Drug-induced immune thrombocytopaenia is a rare, serious condition that can be triggered by numerous medications. To characterize the spectrum of drugs associated with immune thrombocytopaenia (ITP) in the Berlin Case–Control Surveillance Study (FAKOS).

Methods

Adult hospitalized patients with new onset idiopathic, secondary or drug-induced acute ITP and hospital control patients were ascertained by active surveillance in 50 Berlin hospitals (>180 clinical departments) between 2000 and 2009. Drug exposures were obtained in a personal interview. Chronic cases were excluded in a follow-up after 6 or more months. A standardized causality assessment was conducted for each ITP patient to assess possible drug aetiology. Drug risks were quantified in a case–control design with unconditional logistic regression analysis.

Results

Ninety out of 169 validated cases of acute ITP were assessed as being at least possibly drug-related (n = 85 different drugs overall, n = 30 drugs with certain or probable causality). Drugs involved in ≥2 cases with a probable or certain relationship were tirofiban (n = 10 cases), abciximab (n = 4), trimethoprim/sulphamethoxazole (n = 4), influenza vaccine (n = 3), and citalopram (n = 2). Pneumococcal and poliomyelitis vaccine were assessed as probably causing ITP in one case each. In the case–control analyses, significantly increased risks were observed for tirofiban, abciximab, trimethoprim/sulphamethoxazole, gentamicin, triamterene/hydrochlorothiazide, drospirenone/ethinylestradiol, and influenza vaccination.

Conclusions

Our study confirms known ITP risks for glycoprotein IIb/IIIa receptor antagonists and sulphonamides and generates signals for several other drugs and vaccines. New onset of ITP should not only direct attention to drugs as possible aetiological agents, but also to vaccines that are known to cause autoimmune phenomena.

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Acknowledgements

Cases were collected within the study “Berlin Case–Control Surveillance (FAKOS) of Serious Blood Dyscrasias”, which is supported by a grant from the Federal Institute for Drugs and Medical Devices (Bonn, Germany). We wish to thank all the hospitals that contributed cases and controls to this study. A list of all the hospitals is provided in a separate Appendix.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Centre of Clinical Pharmacology and Toxicology, Charité–Universitätsmedizin Berlin, Berlin, Germany

    Edeltraut Garbe, Elisabeth Bronder, Andreas Klimpel & Hanife Kurtal

  2. Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Achterstrasse 30, 28359, Bremen, Germany

    Edeltraut Garbe

  3. Institute for Social Medicine, Epidemiology and Health Economy, Charité–Universitätsmedizin Berlin, Berlin, Germany

    Frank Andersohn

  4. Institute for Transfusion Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany

    Abdulgabar Salama & Oliver Meyer

  5. Department of Surgery, Maria-Heimsuchung Caritas Klinik Pankow, Berlin, Germany

    Michael Thomae

  6. DRK Blood Transfusion Service Baden-Württemberg–Hessen, Institute of Clinical Transfusion Medicine and Immunogenetics Ulm and University Hospital Ulm, Ulm, Germany

    Hubert Schrezenmeier

  7. Interdisciplinary Centre of Cell Therapy, Technical University of Munich, Munich, Germany

    Martin Hildebrandt

  8. Vivantes Klinikum Spandau, Berlin, Germany

    Ernst Späth-Schwalbe

  9. Department of Internal Medicine—Haematology and Oncology, Vivantes Klinikum Neukölln, Berlin, Germany

    Andreas Grüneisen

Authors
  1. Edeltraut Garbe
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  2. Frank Andersohn
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  11. Oliver Meyer
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Corresponding author

Correspondence to Edeltraut Garbe.

Appendix: list of all hospitals contributing cases and controls to this study

Appendix: list of all hospitals contributing cases and controls to this study

Bundeswehrkrankenhaus, Caritas-Klinik Maria Heimsuchung, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Charité Universitätsmedizin Berlin Campus Mitte, Charité Universitätsmedizin Berlin Campus Virchow-Klinikum, Deutsches Herzzentrum Berlin (DHZB), Dominikus-Krankenhaus, DRK Kliniken Berlin-Köpenick, DRK Kliniken Berlin-Mitte, DRK Kliniken Berlin-Westend, Evangelische Elisabeth-Klinik, Evangelisches Geriatriezentrum Berlin (EGZB), Evangelisches Krankenhaus Hubertus, Evangelisches Krankenhaus Königin Elisabeth-Herzberge, Evangelisches Waldkrankenhaus, Evangelische Lungenklinik Berlin, Franziskus-Krankenhaus, Friedrich von Bodelschwingh-Klinik, Gemeinschaftskrankenhaus Havelhöhe, HELIOS Klinikum Berlin Buch, HELIOS Zentralklinik Emil von Behring, Immanuel-Krankenhaus Rheumaklinik Berlin-Wannsee, Immanuel-Krankenhaus Rheumaklinik Berlin-Buch, Jüdisches Krankenhaus, Kliniken im Theodor-Wenzel-Werk, Krankenhaus Bethel, Krankenhaus Hedwigshöhe, Krankenhaus des Maßregelvollzugs, Krankenhaus Waldfriede, Malteser Krankenhaus, Martin-Luther Krankenhaus, Park-Klinik Weißensee, Paulinenkrankenhaus, Sana Klinikum Lichtenberg, Schlosspark-Klinik, St. Gertrauden Krankenhaus, St. Hedwig Krankenhaus, St. Joseph-Krankenhaus, St. Joseph-Krankenhaus Berlin-Weißensee, St. Marien Krankenhaus, Unfallkrankenhaus Berlin, Vivantes Auguste-Viktoria Klinikum, Vivantes Humboldt Klinikum, Vivantes Klinikum am Urban, Vivantes Klinikum im Friedrichshain, Vivantes Klinikum Hellersdorf, Vivantes Klinikum Neukölln, Vivantes Klinikum Prenzlauer Berg, Vivantes Klinikum Spandau, Vivantes Wenckebach-Klinikum, Wichern Krankenhaus

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Garbe, E., Andersohn, F., Bronder, E. et al. Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study. Eur J Clin Pharmacol 68, 821–832 (2012). https://doi.org/10.1007/s00228-011-1184-3

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  • DOI: https://doi.org/10.1007/s00228-011-1184-3

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