Aspirin thrombocytopenia with

Doses and contraindications to glycoprotein Ilb/IIIa receptor blockers are described in Table 5-2. Major bleeding and rates of transfusion are increased with administration of a glycoprotein Ilb/IIIa receptor inhibitor in combination with aspirin and an anticoagulant,30 but there is no increased risk of intracranial hemorrhage in the absence of concomitant fibrinolytic treatment. The risk of thrombocytopenia with tirofiban and eptifibatide appears lower than that with abciximab. Bleeding risks appear similar between agents. 

When linezolid is used with antiplatelet drugs such as aspirin or die NSAIDs (see Chap. 18) diere is an increased risk of bleeding and thrombocytopenia When administered widi die MAOIs (see Chap. 31) the effects of the MAOIs are decreased. There is a risk of severe hypertension if linezolid is combined widi large amounts of food containingtyramine (eg, aged cheese, caffeinated beverages, yogurt, chocolate, red wine, beer, pepperoni). 

E3 monoclonal antibody to GPIIb/llla (abciximab) is very useful as an antiplatelet drug in high-risk ACSs and PCI, It can be used in conjunction with reduced levels of heparin and with aspirin (Table I), Patients may uncommonly experience sudden severe thrombocytopenia within the early hours of treatment as a side effect. 

ASPIRIN SSRIs Possible t risk of bleeding with SSRIs Uncertain. Possible additive effects including inhibition of serotonin release by platelets, SSRI-induced thrombocytopenia, and 1 platelet aggregation Avoid co-administration with high-dose aspirin... 

Currently, the two antiplatelet agents with proven efficacy are aspirin, which inhibits cyclooxygenase -dependent synthesis of thromboxane Aj (TXj ), and ticlopidine, wdrich blocks the ability of ADP to inhibit stimulated adenyl cyclase. Bodi of these drags have proven prophylactic uses in reducing the risk of thrombo -occlusive and thromboembolic complications for all major arterial beds in individuals with a previous history of such episodes. Controlled trials show that both aspirin and ticlopidine are indicated in the secondary prevention of stroke, myocardial induction and peripheral vascular occlusion. However, there are limitations to their efficacy. No net changes in vascular events are seen with primary prevention. Moreover, antiplatelet drugs do not alter thrombocytopenia or impairment... 

Thrombocytopenia, agranulocytosis, neutropenia, aplastic anemia, and even pancytopenia have been reported in association with aspirin. The prospect for recovery from the latter is poor, mortality approaching 50%. 

E Discontinue abciximab, aspirin, and heparin and give a platelet transfusion. Because abciximab is associated with thrombocytopenia, platelet counts should be monitored carefully. The manufacturer recommends that a platelet count be obtained prior to initiation of abciximab, 2 to 4 hours following the bolus dose, and 24 hours after discontinuing abciximab or prior to patient discharge. If thrombocytopenia is verified, then the following should be employed (see Table A-14). 

Ibuprcfen is thought to be better tolerated than aspirin and indomethacin and has been used in patients with a history of gastrointestinal intolerance to other NSAIDs. Nevertheless, 5-15% of patients experience GI side effects. Less frequent adverse effects include thrombocytopenia, rashes, headache, dizziness, blurred vision, and in a few cases toxic amblyopia, fluid retention, and edema. Patients who develop ocular disturbances should discontinue the use of ibuprofen. Ibuprofen can be used occasionally by pregnant women however, the concerns apply regarding third-trimester effects. Excretion into breast milk is thought to be minimal, so ibuprofen also can he used with caution by women who are breastfeeding. 

Appropriate analgesia should always be given. Aspirin and nonsteroidal anti-inflammatory drugs with anti-platelet action should be avoided due to the relative thrombocytopenia associated with ARS. 

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