Hospital Pharmacy - February 2018 - 43

Muhammad et al
Table 2. Ibuprofen Administration in Patients With an Active Ibuprofen Order, and a Platelet Count of <100 000/µL or ≥100 000/µL.
Platelet count of <100 000/µL (n = 3)

Platelet count of ≥100 000/µL (n = 15)

3 (100)
666.7 ± 188.6

10 (66.7%)
452.6 ± 130.7

Ibuprofen administration, no. (%)
Ibuprofen dose administered, mg, mean ± SD
Note. n = number of patients with an active ibuprofen order.

Discussion

Declaration of Conflicting Interests

This study demonstrated that including ibuprofen as an automatic/preselected standard order within the opioid withdrawal protocol order set resulted in patients receiving
ibuprofen which may put patients with concomitant thrombocytopenia at a higher risk for bleeding. One recommendation to mitigate this risk is to remove ibuprofen as an
automatic standard order within predetermined order sets. In
addition, acetaminophen could be considered as a potential
alternative, at least until the platelet count rebounds, though
the data for acetaminophen use in this patient population is
not as robust as it is with NSAIDs.10 Of note, the use of acetaminophen in patients with an alcohol use disorder may be
questioned, especially when there is an evidence of liver disease. However, several studies have demonstrated that ingestion of acetaminophen within recommended doses (up to 4
grams per day) did not produce an increase in hepatic aminotransferase enzyme levels or any clinical manifestations of
hepatic toxicity among patients with alcohol use
disorder.11,12

The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Limitations
There are limitations to this study that are worth noting.
One limitation of this study is its small sample size. Another
limitation is the potentially high cut-off value for platelet
count of <150 000/µL for the study definition of thrombocytopenia. Even though this platelet count meets the definition of thrombocytopenia, the risk of bleeding may be
relatively lower until platelet count drops further.1,13
Another limitation of this study is that the physicians' reasoning for discontinuation of ibuprofen in certain patients
was unclear.

Conclusion
More than 70% of patients identified had an active order for
ibuprofen and 50% of these patients received ibuprofen.
Patients with a platelet count of <100 000/µL were more
likely to be receive ibuprofen in presence of an active ibuprofen order and received a higher dose of ibuprofen than
those who had a platelet count of ≥100 000/µL. This study
illustrates a potential medication safety concern in patients
with alcohol-related thrombocytopenia who are inadvertently ordered ibuprofen. Future, long-term studies are warranted to confirm the findings.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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https://www.ncbi.nlm.nih.gov/books/NBK64116/

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