PURPOSE: Proton pump inhibitor (PPI) continuous infusions are used in the treatment of acute upper gastrointestinal bleeds (GIB). PPIs are relatively safe however, in clinical practice, they have been supposedly linked to thrombocytopenia. Recent literature showed no increased incidence of thrombocytopenia with oral pantoprazole. However, data regarding the accurate incidence of thrombocytopenia with continuous infusion of PPIs is lacking and our study attempts to quantify this incidence.
METHODS: This is a retrospective study of 160 patients admitted over a one-year period for acute GIB and treated with continuous intravenous infusion of pantoprazole. Exclusion criteria included a treatment period lasting less than 48 hours. Two treatment arms were studied: patients with normal platelet counts versus patients with counts less than 150,000 on admission. Thrombocytopenia was defined as platelets less than 150,000 at the termination of treatment, or a drop in platelets greater than 50% when compared to pre-treatment values. Medication lists and histories were assessed for other possible etiologies of thrombocytopenia.
RESULTS: One hundred sixty patients received pantoprazole infusion for more than 48 hours. Forty patients were identified with pre-existing thrombocytopenia. Of the remaining 120 patients, 28 (23%) developed thrombocytopenia with pantoprazole therapy. Only 8 of these 28 patients (6.6%) had no comorbidities or medications that could promote thrombocytopenia. This percentage is comparable to the incidence associated with oral pantoprazole. Of the 40 patients with pre-existing thrombocytopenia, only 3 patients (7.5%) had their platelet drops more than 50%. Moreover, 20 of these patients (50%) actually experienced an elevation of their platelet count while on PPI therapy.
CONCLUSION: Our study showed a low incidence of thrombocytopenia related to pantoprazole continuous infusion. Furthermore, our study showed that the medication is safe also for patients with pre-existing thrombocytopenia. We conclude that thrombocytopenia is not a significant side effect of continuous parenteral pantoprazole infusion.
CLINICAL IMPLICATIONS: Pantoprazole continuous infusion can be safely used in patients with GIB, even with pre-existing thrombocytopenia. Should thrombocytopenia develop during the course of treatment, other etiologies should be investigated.
DISCLOSURE: Efrat Dotan, None.