Arterial and Venous Thromboses in Patients With Idiopathic (Immunological) Thrombocytopenia: A Possible Contributing Role of Cortisone-Induced Hypercoagulable State

作者:Girolami Antonio*; de Marinis Gulia Berti; Bonamigo Emanuela; Treleani Martina; Vettore Silvia
来源:Clinical and Applied Thrombosis/Hemostasis, 2013, 19(6): 613-618.
DOI:10.1177/1076029612452114

摘要

Immunological thrombocytopenias, as other forms of thrombocytopenia, are associated with bleeding. Occasionally, these patients manifest thrombotic events. A total of at least 29 patients were reported to have had either arterial (20 cases) or venous (9 cases) thrombosis while platelet count was less than 50 x 10(3)/L. The most frequent clinical manifestation was a myocardial infarction. Thrombosis occurred in the large majority of patients during prednisone therapy. Patients receiving cortisone or patients with Cushing syndrome show a hypercoagulable state characterized by elevated factor VIII levels, decreased fibrinolysis, and abnormal von Willebrand factor multimers composition. The same is probably true for prednisone-treated patients with thrombocytopenia. However, the 2 conditions are not identical since prednisone is a mainly glycoactive compound, whereas cortisol produced in excess in Cushing syndrome is mainly mineraloactive. The presence of large, young, hyperactive platelets may also play a role. Prednisone-treated patients with thrombocytopenia have to be considered as potentially thrombophilic.

  • 出版日期2013-11