title: [Hypercoagulation syndrome in multiple myeloma].
abstract: OBJECTIVE
  To determine the frequency and pattern of blood clotting disorders in patients with multiple myeloma (MM) and to evaluate the adequacy of preventive anticoagulant or antiaggregant therapy.
  
  
  METHODS
  The prospective study conducted at the Department for High-Dose Chemotherapy and Bone Marrow Transplantation, Hematology Research Center, Ministry of Health of the Russian Federation, in March 2012 to May 2013, enrolled 25 patients (13 men and 12 women) aged 29-72 years (median age 54 years) with new-onset MM. The latter was staged using the Durie-Salmon classification: Stages I, II, and III were determined in 2, 10, and 13 patients, respectively. Seven patients were found to have renal dysfunction (which corresponded to Substage B). The hemostasis was evaluated from the results of the following tests: activated partial thromboplastin time (APTT), thrombin time (TT), Xlla-dependent fibrinolysis time, Quick prothrombin index, international normalized ratio (INR), and fibrinogen and D-dimer concentrations. The investigators used new hemostatic techniques, such as thrombin generation test, thromboelastography, as well as thrombodynamics, a novel method to determine the characteristics of spatial clot growth. Induction therapy was performed using the PAD and VCD regimens. Thromboses were prevented by using 24-hour infusion of unfractionated heparin (500 U/hr) or by administering aspirin (100 mg/day).
  
  
  RESULTS
  Hypercoagulability was identified in 17 (68%) patients. Eleven (44%) patients had elevated D-dimer concentrations. The level of D-dimer was statistically significantly positively correlated with the endogenous thrombin potential and the amount of beta2-microglobulin. The thrombodynamic technique revealed an inverse relationship between the level of paraprotein and the optimal density of a fibrin clot. A thrombotic episode was seen in one elderly (71-year-old) patient after aspirin discontinuation during long-term immobilization.
  
  
  CONCLUSIONS
  Nearly 50% of the primary patients with MM were ascertained to be more prone to thrombosis. Infusion of unfractionated heparin in a dose of 500 U/hr or administration of aspirin (100 mg/day) was the adequate prevention of thrombotic events.
authors.forename: E S
authors.initials: ES
authors.lastname: Urnova
authors.forename: O S
authors.initials: OS
authors.lastname: Pokrovskaia
authors.forename: M A
authors.initials: MA
authors.lastname: Gracheva
authors.forename: S A
authors.initials: SA
authors.lastname: Vasil'ev
authors.forename: É G
authors.initials: ÉG
authors.lastname: Gemdzhian
authors.forename: I D
authors.initials: ID
authors.lastname: Tarandovskiĭ
authors.forename: L P
authors.initials: LP
authors.lastname: Mendeleeva
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D013577:Syndrome; D019851:Thrombophilia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin