A comparative evaluation of adverse platelet outcomes among Veterans' Affairs patients receiving linezolid or vancomycin.
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Issue Date
2012-03
Authors
Patel, Nimish
VanDeWall, Hillary
Tristani, Linda
Rivera, Antonio
Woo, Benjamin
Dihmess, Amanda
Li, Hsin K
Smith, Raymond P
Lodise, Thomas P
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Abstract
OBJECTIVES: The primary objectives were to compare the incidences of severe thrombocytopenia, critical thrombocytopenia and a relative decline in platelets from baseline (>/=50% decline) between patients receiving linezolid and those receiving vancomycin. The secondary objective was to assess the relationship between vancomycin trough concentration and adverse platelet outcomes.
METHODS: A matched cohort study was performed at the Upstate New York Veterans' Affairs Healthcare Network from January 2005 until February 2008. Eligibility criteria were: (i) receipt of linezolid or vancomycin therapy for >/=48 h; (ii) initiation of therapy as an inpatient; and (iii) baseline platelets available for evaluation. Patients who received linezolid were matched 1:1 to patients who received vancomycin. Cumulative incidences and times to event for (i) platelet count </=50,000 cells/mm(3), (ii) platelet count </=20,000 cells/mm(3) and (iii) >/=50% decline in platelets from baseline were evaluated. Multivariate analyses were performed.
RESULTS: The study included 502 patients (251 matched pairs). The occurrences of platelet counts </=50,000 cells/mm(3) and </=20,000 cells/mm(3) did not differ significantly between linezolid and vancomycin patients. A >/=50% decline in platelets from baseline was observed in 78 (31.1%) patients receiving vancomycin and 43 (17.1%) patients receiving linezolid (risk ratio 0.55; 95% CI 0.40-0.77). A clear exposure-response relationship was observed between vancomycin trough concentration and >/=50% decline in platelets from baseline.
CONCLUSIONS: The incidence of thrombocytopenia was low and did not differ significantly among vancomycin and linezolid patients.
Citation
Patel N, VanDeWall H, Tristani L, Rivera A, Woo B, Dihmess A, Li HK, Smith R, Lodise TP. A comparative evaluation of adverse platelet outcomes among Veterans' Affairs patients receiving linezolid or vancomycin. J Antimicrob Chemother. 2012 Mar;67(3):727-35. doi: 10.1093/jac/dkr522. Epub 2011 Dec 15. PMID: 22174041.
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