Pantoprazole-Induced Thrombocytopenia in a Patient with Upper Gastrointestinal Bleeding: A Case Report

Abstract

Although it seems relatively rare, pantoprazole-induced thrombocytopenia is a potentially serious side effect[6]. Proton pump inhibitors (PPIs), which have the potential to stabilize blood clot formation, are frequently used in the treatment of upper gastrointestinal bleeding (UGIBs)[7]. Helicobacter pylori infection, stomach ulcers, erosive esophagitis, and stress ulcer prophylaxis in high-risk critically ill individuals are the indications for PPI therapy. In intensive care units (ICUs), stress ulcer prophylaxis with acid-suppressing therapy is frequently prescribed. PPIs are a class of medications that are routinely used in intensive care units (ICU) to treat and prevent stress ulcers (stress-related mucosal disease). The mainstay of treatment for peptic ulcer bleeding includes PPIs, with consensus recommendations currently prescribing high-dose intravenous (IV) PPI therapy (IV bolus followed by continuous therapy).2 PPIs have been demonstrated to lessen symptoms of bleeding at index endoscopy and to lessen rebleeding following endoscopic hemostasis. Although PPIs are well-tolerated and frequently given to patients with acute UGIBs, serious side effects could happen. Patients who used PPIs for a brief period of time experienced a variety of moderate systemic symptoms. When taking PPIs for less than two weeks, serious adverse effects typically start off moderate. However, as treatment time goes on, side effects have been found to become more frequent and severe.  Patients with UGIBs may experience significant hemodynamic instability and rebleeding risks due to thrombocytopenia. Here, we present a case of thrombocytopenia that developed after pantoprazole was introduced. After the drug was discontinued, the thrombocytopenia was recovered. According to the Naranjo probability scale causality assessment, the relationship between thrombocytopenia and pantoprazole is found to be probable. We emphasize this case to raise awareness about drug-induced thrombocytopenia.