Arterial and venous thromboses in patients with idiopathic (immunological) thrombocytopenia: a possible contributing role of cortisone-induced hypercoagulable state.
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 × 10(3)/μL. 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.
1Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy.
Antonio
A
Girolami
Gulia Berti
GB
de Marinis
Emanuela
E
Bonamigo
Martina
M
Treleani
Silvia
S
Vettore
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003348:Cortisone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood* / Q000276:immunology / Q000473:pathology; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood* / Q000276:immunology / Q000473:pathology; D020246:Venous Thrombosis / Q000097:blood* / Q000139:chemically induced* / Q000276:immunology / Q000517:prevention & control; D055815:Young Adult
D003348:Cortisone