Abstract
Objective Perinatal thrombocytopenia has been shown to affect responsiveness to therapeutic
ductal closure with cyclooxygenase (COX) inhibitors. This has not been studied in
responsiveness to acetaminophen, which has less effect on platelet function. The objective
of this study was to evaluate whether thrombocytopenia affects ductal responsiveness
to acetaminophen.
Study Design This study was a retrospective review of preterm neonates <1,500 g. Echocardiograms
were performed within the first week of life; if ductal status was found to be hemodynamically
significant, infants were treated with acetaminophen.
Results We studied 254 infants. Fifty-seven of these (22%) had a hemodynamically significant
patent ductus arteriosus (hsPDA) and were treated with acetaminophen. Forty (70%)
of those treated responded with ductal closure after one to two courses of acetaminophen.
Seventeen infants were considered nonresponsive, requiring the addition of ibuprofen
and/or surgical ligation. Sixty seven of the 254 infants (26%) developed moderate
thrombocytopenia (platelets <100,000) within the first 10 days of life, more within
the hsPDA group (54 vs. 18% p < 0.001); however, no differences in platelet-related parameters were observed between
those who did and did not respond to acetaminophen treatment when comparing infants
with hsPDA. Twenty-six of the 67 thrombocytopenic infants were already thrombocytopenic
prior to acetaminophen treatment, and 19 of these 26 (73%) with pretreatment thrombocytopenia
responded to acetaminophen treatment—with the overall response rate of 70%.
Conclusions This study is the first to document that, in contrast to the COX inhibitors, there
is no association between early neonatal thrombocytopenia and ductal therapeutic responsiveness
to acetaminophen.
Key Points
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Perinatal thrombocytopenia affects ductal closure with COX inhibitors.
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In contrast to the COX inhibitors, acetaminophen responsiveness is not affected by
thrombocytopenia.
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Acetaminophen can be recommended to close hsPDA in the presence of thrombocytopenia.
Keywords
acetaminophen - thrombocytopenia - patent ductus arteriosus - preterm neonate
