Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports

Thrombocytopenia induced by proton pump inhibitors (PPIs) is a relatively uncommon adverse effect of this widely prescribed class of drugs. The objective of this study is to investigate the clinical features of PPIs-induced thrombocytopenia based on published case reports.

We searched the PubMed, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang Data, and Chinese VIP databases from inception to August 2024 to identify reported cases of thrombocytopenia associated with PPIs use. Clinical data such as patient demographics, drug use information, adverse reactions, and outcomes were extracted and analyzed.

Overall, 16 publications describing 18 cases (12 males and 6 females) were included in this study, comprising a neonate and 17 adults with a median age of 62 years (range 23-98). The PPIs associated with thrombocytopenia included pantoprazole (11 cases), lansoprazole (4 cases), omeprazole (2 cases), and esomeprazole (1 case). The median time to symptoms onset was 3 days (range 2-7) after the initiation of PPI therapy. After discontinuation of PPIs and interventions such as platelet transfusion, 11 patients achieved recovery, and the remaining 7 patients experienced symptomatic improvement.

Thrombocytopenia induced by PPIs appears to be a rare adverse event. Clinicians should enhance their awareness when evaluating potential cases of thrombocytopenia. Once PPIs are suspected, immediate discontinuation of the drugs and initiation of appropriate treatments are recommended.