Purpura and bleeding due to calcium channel blockers: A preliminary study

Authors

  • Carounanidy Udayashankar
  • Charanya Sathyamoorthy
  • Dr. Bhuvaneswari
  • Amiya Kumar Nath

Keywords:

Purpura, bleeding, calcium channel blockers, amlodipine

Abstract

Objective To estimate the frequency of purpura and bleeding in patients on calcium channel blockers and association between calcium channel blocker therapy and petechiae due to capillary fragility induced by Hess test. Methods A facility based cross-sectional study was conducted involving 60 adult patients only on calcium channel blockers (CCBs) for cardiovascular causes for at least 3 months duration. All the patients were questioned about the spontaneous occurrence of purpura and were examined for purpura. Hess test was performed in all the subjects and the result noted. Patients also underwent investigations to rule out other causes of purpura or bleeding. Results None of the 60 hypertensive patients included in our study who were only on amlodipine, a calcium channel blocker, had any history suggestive of or examination findings suggestive of spontaneous bleeding or occurrence of purpura. Abnormal Hess test was also not seen in any of the subjects. Platelet count, bleeding time, clotting time and prothrombin time, the key investigations in cases of bleeding disorders were all normal in all the subjects. Conclusion The results of our study showed that treatment with calcium channel blockers (CCBs), particularly amlodipine, is not related to purpura or bleeding. Our study also shows that therapy with the CCB amlodipine is not associated with petechiae due to capillary fragility induced by Hess test.

References

Abernethy D, Schwartz J. Calcium-channel antagonists drugs. N Engl J Med. 1999;341:1447-57.

Gore JM, Sloan M, Price TR, Randall AM, Bovill E, Collen D et al. Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the thrombolysis in myocardial infarction study: thrombolysis in myocardial infarction, phase II, pilot and clinical trial. Circulation. 1991;83:448- 59

Pahor M, Guralnik JM, Furberg CD, Carbonin P, Havlik RJ. Risk of gastrointestinal haemorrhage with calcium antagonists in hypertensive persons over 67 years old. Lancet.1996;347:1061-5.

Rodriguez LAC, Cattaruzzi C, Troncon MG, Agostinis L. Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists and other antihypertensive drugs. Arch Intern Med. 1998;15:833-9.

Kaplan RC, Heckbert SR, Koepsell TD, Rosendaal FR, Psaty BM. Use of calcium channel blockers and risk of hospitalized gastrointestinal bleeding. Arch Intern Med. 2000;160:1849-55.

Wagenknecht LE, Furberg CD, Hammon JW, Legault C, Troost BT. Surgical bleeding: unexpected effect of a calcium antagonist. BMJ. 1995;310:776-7.

Kuo M, Winiarski N, Garella S. Nonthrombocytopenic purpura associated sequentially with nifedipine and diltiazem. Ann Pharmacother. 1992;26:1089-90.

Inui S, Itami S, Yoshikawa K. A case of lichenoid purpura possible caused by diltiazem hydrochloride. J Dermatol. 2001;28:100-2.

Murthy MB, Murthy B. Amlodipine-induced petechial rash. J Postgrad Med. 2011;57:341-2.

Garbe E, Meyer O, Andersohn F, Aslan T, Kiesewetter H, Salama A. Amlodipine-induced immune thrombocytopenia. Vox Sang. 2004;86:75-6.

Cox NH, Walsh ML, Robson RH. Purpura and bleeding due to calcium-channel blockers: an underestimated problem? Case reports and a pilot study. Clin and Exp Dermatol. 2008;34:487-91.

Cox NH, Piette WW. Purpura and microvascular occlusion. In: Burn T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology, 8th edn. Oxford: Wiley-Blackwell; 2010. P. 49.1-49.51.

Ducan SC, Winkelmann RK. Early histopathology of the cutaneous capillary fragility test (Rumpel-Leede). J Cutan Pathol. 1979;6:1-4.

Pilotto A, Leandro G, Franceschi M, Di Mario F, Valerio G. Antagonism to calcium antagonists [letter]. Lancet. 1996;347:1761- 2.

Suissa S, Bourgault C, Barkun A, Sheehy O, Ernst P. Antihypertensive drugs and the risk of gastrointestinal bleeding. Am J Med. 1998;105:230-5.

Smalley WE, Ray WA, Daugherty JR, Griffin MR. No association between calcium channel blocker use and confirmed bleeding peptic ulcer disease. Am J Epidemiol. 1998;148:350-4.

Kelly JP, Laszlo A, Kaufman DW, Sundstrom A, Shapiro S. Major upper gastrointestinal bleeding and the use of calcium channel blockers [letter]. Lancet. 1999;353:559.

Ioulios P, Charalampos M, Efrossini T. The spectrum of cutaneous reactions associated with calcium antagonists: A review of the literature and the possible etiopathogenic mechanisms. Dermatol Online J. 2003;9(5):6.

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Published

2017-04-12

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Original Articles