Probable Etoricoxib-Induced Severe Thrombocytopenia: A Case Report

Recinella, Guerino; Marchi, A; Pirazzoli, Enrico; Bianchi, Giampaolo

doi:10.1159/000496975

Cited by 3 publications

(1 citation statement)

References 11 publications

(15 reference statements)

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“…The present study found lower platelet COX-2 expression in adult ITP patients and a positive correlation between COX-2 protein expression and platelet count. These clinical results were hardly reported in ITP but consistent with previous studies beyond ITP, as there has been a reported case of severe drug-induced immune thrombocytopenia (DITP) caused by the selective COX-2 inhibitor etoricoxib [ 34 ]. And meta-analyses of COX-2 inhibitors in treating non-small cell lung cancer concluded that COX-2 inhibitors may increase the risk of thrombocytopenia [ 35 – 37 ].…”

Section: Discussionsupporting

confidence: 89%

Decreased cyclooxygenase-2 associated with impaired megakaryopoiesis and thrombopoiesis in primary immune thrombocytopenia

Zhuang,

Xu,

et al. 2023

J Transl Med

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Background Cyclooxygenase (COX)-2 is a rate-limiting enzyme in the biosynthesis of prostanoids, which is mostly inducible by inflammatory cytokines. The participation of COX-2 in the maturation of megakaryocytes has been reported but barely studied in primary immune thrombocytopenia (ITP). Methods The expressions of COX-2 and Caspase-1, Caspase-3 and Caspase-3 p17 subunit in platelets from ITP patients and healthy controls (HC), and the expressions of COX-2 and CD41 in bone marrow (BM) of ITP patients were measured and analyzed for correlations. The effects of COX-2 inhibitor on megakaryopoiesis and thrombopoiesis were assessed by in vitro culture of Meg01 cells and murine BM-derived megakaryocytes and in vivo experiments of passive ITP mice. Results The expression of COX-2 was decreased and Caspase-1 and Caspase-3 p17 were increased in platelets from ITP patients compared to HC. In platelets from ITP patients, the COX-2 expression was positively correlated with platelet count and negatively correlated to the expression of Caspase-1. In ITP patients BM, the expression of CD41 was positively correlated with the expression of COX-2. COX-2 inhibitor inhibited the count of megakaryocytes and impaired the maturation and platelet production in Meg01 cells and bone marrow-derived megakaryocytes. COX-2 inhibitor aggravated thrombocytopenia and damaged megakaryopoiesis in ITP murine model. Conclusion COX-2 plays a vital role in the physiologic and pathologic conditions of ITP by intervening the survival of platelets and impairing the megakaryopoiesis and thrombopoiesis of megakaryocytes.

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Section: Discussionsupporting

confidence: 89%

Decreased cyclooxygenase-2 associated with impaired megakaryopoiesis and thrombopoiesis in primary immune thrombocytopenia

Zhuang,

Xu,

et al. 2023

J Transl Med

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Etoricoxib

2019

Reactions Weekly

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Spontaneous bleeding from orbital haemangioma in drug-induced thrombocytopaenia

Yen

Chen

2021

BMJ Case Rep

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An 81-year-old woman, a drug-induced thrombocytopaenia (DITP) patient, presented with a case of spontaneous bleeding from an orbital haemangioma manifesting as a sudden onset of ocular pain, proptosis and limited eye movement. Image studies revealed an extraconal, cystic lesion with haemorrhage. The ophthalmopathy was caused by the bleeding of the orbital haemangioma and it was resolved after embolisation of the feeding vessels. Spontaneous bleeding of orbital haemangioma is rare. This case emphasises that DITP may be the cause of spontaneous bleeding of orbital haemangioma by precipitating the inflammatory reactions within the tumour, which further cause the haemodynamic disturbances and ultimate spontaneous bleeding.

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Probable Etoricoxib-Induced Severe Thrombocytopenia: A Case Report

Cited by 3 publications

References 11 publications

Decreased cyclooxygenase-2 associated with impaired megakaryopoiesis and thrombopoiesis in primary immune thrombocytopenia

Decreased cyclooxygenase-2 associated with impaired megakaryopoiesis and thrombopoiesis in primary immune thrombocytopenia

Etoricoxib

Spontaneous bleeding from orbital haemangioma in drug-induced thrombocytopaenia

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