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Diltiazem-associated thrombocytopenia

E L Michalets¹, D V Jackson

¹Department of Pharmacy, Mission-St. Joseph's Health System, Asheville, North Carolina 28801, USA.

Pharmacotherapy

|December 17, 1997

Summary

Diltiazem therapy for atrial fibrillation can cause severe thrombocytopenia (low platelet count). This immune-mediated condition resolved after discontinuing diltiazem and receiving immunoglobulin treatment.

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Area of Science:

Cardiology
Hematology
Pharmacology

Background:

Atrial fibrillation is a common cardiac arrhythmia.
Diltiazem is a calcium channel blocker used to treat atrial fibrillation.
Drug-induced thrombocytopenia is a potential adverse effect of various medications.

Observation:

A patient on diltiazem for new-onset atrial fibrillation developed severe thrombocytopenia.
Platelet counts dropped significantly, reaching a nadir of 23 x 10(3)/mm3.
Platelet transfusions were ineffective, and bone marrow examination suggested peripheral destruction.

Findings:

The case suggests diltiazem-induced immune-mediated thrombocytopenia.
Discontinuation of diltiazem led to platelet count normalization.
High-dose immunoglobulin infusions aided in platelet count recovery.

Implications:

Clinicians should consider diltiazem as a potential cause of thrombocytopenia in patients with atrial fibrillation.
Prompt recognition and management, including drug withdrawal and immunotherapy, are crucial for recovery.
This case highlights the importance of monitoring hematologic parameters during diltiazem therapy.

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