Acute thrombocytopenia with acetylsalicylic acid: a case report

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Background Acetylsalicylic acid-associated thrombocytopenia is rare and has mainly been described in isolated case reports. We report a case of acute thrombocytopenia temporally associated with an acetylsalicylic acid-containing preparation in an elderly patient with multiple comorbidities.Case report A 71-year-old woman developed abrupt thrombocytopenia during hospitalisation, with platelet counts decreasing from 338 × 109/L to 25 × 109/L without major bleeding manifestations. Peripheral blood smear confirmed marked thrombocytopenia without platelet aggregation or schistocytes. The acetylsalicylic acid-containing preparation was discontinued, whereas Linagliptin treatment was continued. Platelet counts subsequently recovered and normalised during follow-up. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale supported a probable drug-related association.Discussion Previous reports have suggested possible immune-mediated and idiosyncratic mechanisms for acetylsalicylic acid-associated thrombocytopenia. Although alternative etiologies could not be completely excluded in the present case, the temporal relationship between drug exposure and platelet recovery after withdrawal supported a possible association. Clinicians should remain aware that acetylsalicylic acid-containing preparations may potentially contribute to severe haematologic adverse events, particularly in elderly patients with multiple comorbidities and polypharmacy.