Raloxifene enhances spontaneous microaggregation of platelets through upregulation of p44/p42 MAP kinase: a case report.
A 60-year-old postmenopausal woman diagnosed as primary osteoporosis began to take raloxifene. The spontaneous microaggregates of platelets induced by shear stress were accelerated after the treatment, concomitant with the significant upregulation of p44/p42 mitogen-activated protein (MAP) kinase induced by adenosine diphosphate (ADP). After the cessation of raloxifene, the spontaneous microaggregates of platelets and the acceleration of ADP-induced p44/p42 MAP kinase phosphorylation was diminished. We concluded that raloxifene caused platelet hyperaggregability to shear stress and p44/p42 MAP kinase was involved in the pathological state.


BACKGROUND
A 60-year-old postmenopausal woman suffering from severe lumbago was diagnosed as primary osteoporosis with combined vertebral fractures. After the acute phase, she began to take 60 mg daily of oral raloxifene. The spontaneous microaggregates of platelets induced by shear stress were accelerated significantly after 8 weeks from the beginning of raloxifene treatment and observed at 12 weeks.


RESULTS
The platelet aggregation induced by ADP was little changed; however, low doses (0.3 and 1 microM) of ADP significantly induced the phosphorylation of p44/p42 MAP kinase in the platelets obtained at 12 weeks. Although there were few subjective complaints except for paroxysmal headache, the medication was stopped with her consent to avoid any adverse effects. The spontaneous microaggregates of platelets gradually decreased after the cessation of medication. At 12 weeks after the cessation, the phosphorylation of p44/p42 MAP kinase induced by low doses of ADP was no more observed.


CONCLUSIONS
These results strongly suggest that raloxifene caused platelet hyperaggregability to shear stress and subclinical thrombus formation in this case and that p44/p42 MAP kinase was involved in the pathological state.
Department of Clinical Laboratory, National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan. tokuda@ncgg.go.jp
H
H
Tokuda
A
A
Harada
S
S
Adachi
R
R
Matsushima-Nishiwaki
H
H
Natsume
C
C
Minamitani
J
J
Mizutani
T
T
Otsuka
O
O
Kozawa
D001792:Blood Platelets / Q000201:enzymology; D050071:Bone Density Conservation Agents / Q000494:pharmacology*; D002478:Cells, Cultured; D005260:Female; D006801:Humans; D008875:Middle Aged; D019950:Mitogen-Activated Protein Kinase 1 / Q000097:blood*; D048052:Mitogen-Activated Protein Kinase 3 / Q000097:blood*; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000188:drug therapy; D010974:Platelet Aggregation / Q000187:drug effects* / Q000502:physiology; D020849:Raloxifene Hydrochloride / Q000494:pharmacology*; D015854:Up-Regulation / Q000187:drug effects
D050071:Bone Density Conservation Agents; D020849:Raloxifene Hydrochloride; D019950:Mitogen-Activated Protein Kinase 1; D048052:Mitogen-Activated Protein Kinase 3