Linezolid and Thrombocytopenia

Q: 76 year old female is admitted from Nursing Home with severe Vancomycin resistant Enterococcus (VRE) pressure ulcer cellulitis. Linezolid is started by infectious diseases (ID) service. ICU fellow is worried about development of thrombocytopenia due to concurrent sepsis. What is the time lag between Linezolid initiation and Thrombocytopenia?

Answer: On average 7-14 days 

Thrombocytopenia could be multifactorial in ICU. One of the causes is Linezolid (Zyvox). But, thrombocytopenia with linezolid usually doesn't occur right away, and take up to 1-2 weeks with the initiation of treatment and could help in ruling out at least one reason. 

Relatively overall its mild, reversible and due to myelosuppression. There is no evidence for any anti-platelet mechanism or interference with platelet function. Said that one article in recent literature from machine learning, without clinical testing, claims to increase mortality and ICU Length of Stay (LOS).

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References: 

1. Green SL, Maddox JC, Huttenbach ED. Linezolid and Reversible Myelosuppression. JAMA. 2001;285(10):1291. doi:10.1001/jama.285.10.1291

2. Takahashi Y, Takesue Y, Nakajima K, Ichiki K, Tsuchida T, Tatsumi S, Ishihara M, Ikeuchi H, Uchino M. Risk factors associated with the development of thrombocytopenia in patients who received linezolid therapy. J Infect Chemother. 2011 Jun;17(3):382-7. doi: 10.1007/s10156-010-0182-1. Epub 2010 Dec 3. PMID: 21127934.

3. Giunio-Zorkin N, Brown G. Real-Life Frequency of New-Onset Thrombocytopenia during Linezolid Treatment. Can J Hosp Pharm. 2019 Mar-Apr;72(2):133-138. Epub 2018 Apr 30. PMID: 31036974; PMCID: PMC6476580.

4. Maray I, Rodríguez-Ferreras A, Álvarez-Asteinza C, Alaguero-Calero M, Valledor P, Fernández J. Linezolid induced thrombocytopenia in critically ill patients: Risk factors and development of a machine learning-based prediction model. J Infect Chemother. 2022 Sep;28(9):1249-1254. doi: 10.1016/j.jiac.2022.05.004. Epub 2022 May 14. PMID: 35581121.