Clinical and literature case analysis on levetiracetam-induced thrombocytopenia
10.3760/cma.j.cn114015-20200403-00371
- VernacularTitle:左乙拉西坦相关血小板减少临床及文献病例分析
- Author:
Hao GUO
1
;
Shibo QI
;
Tiantian ZHOU
;
Zhanmiao YI
Author Information
1. 内蒙古自治区人民医院药学处，呼和浩特 010017（曾在北京大学第三医院药剂科进修，北京 100191）
- Publication Type:Journal Article
- Keywords:
Thrombocytopenia;
Pancytopenia;
Drug-related side effects and adverse reactions;
Levetiracetam
- From:
Adverse Drug Reactions Journal
2020;22(12):677-682
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of thrombocytopenia caused by levetiracetam (LEV).Methods:The diagnosis and treatment of a patient with thrombocytopenia caused by LEV in Peking University Third Hospital were reported. The main clinical data (gender, age, indications of LEV medication, usage and dosage of LEV, comorbidities, combined medication, platelet count before and after medication, time from LEV medication to onset of thrombocytopenia, clinical management and outcome, etc.) of the case and relevant cases collected from PubMed, Embase, CNKI, and Wanfang database (as of February 1, 2020) were summarized and analyzed.Results:A total of 14 patients were enrolled in the study, including 4 males and 10 females, aged from 4 months to 79 years with a median age of 57 years. There were 5 cases of primary epilepsy and 9 cases of secondary epilepsy, including 4 cases of stroke secondary epilepsy, 4 cases of brain tumor secondary epilepsy, and 1 case of viral encephalitis. Among them, 8 patients had low immune function; 4 patients were treated with LEV alone and 10 were treated with LEV combined with other antiepileptic drugs. The time from the application of LEV to onset of thrombocytopenia was 2-150 days and the median time was 8.5 (3.2, 18.5) days after medication. The severity of thrombocytopenia was defined as grade 1, 2, 3, and 4 in 1, 4, 1, and 8 patients, respectively. After the onset of thrombocytopenia, LEV was discontinued in all the 14 patients. Of them, 9 cases were improved without special intervention, 4 cases were improved after symptomatic treatments (with human immunoglobulin, hormone, and platelet transfusion in 1 case, human immunoglobulin, hormone, and anti-CD20 monoclonal antibody in 1 case, and intravenous platelet transfusion in 2 cases), and a 4-month-old infant died of septic shock and multiple organ failure.Conclusion:LEV-related thrombocytopenia may occur 2-150 days after the first medication and usually in patients with immunodeficiency, which could be improved by drug withdrawal alone or combination with symptomatic treatments as appropriate.
