title: Thrombotic events in acute promyelocytic leukemia.
abstract: BACKGROUND
  Thrombotic events (TE) appear to be more common in acute promyelocytic leukemia (APL) than in other acute leukemias, with reported prevalence ranging from 2 to 10-15%.
  
  
  METHODS
  We retrospectively analyzed the data on TE appearance in 63 APL patients.
  
  
  RESULTS
  TE occured in 13 (20.6%) cases, four arterial (6.3%) and nine venous (14.3%). TE were more frequently diagnosed after initiation of weekly D-dimer monitoring (7 TE during 20 months vs 6 during 76 months, P=0.032). Patients with and without venous thrombosis were significantly different regarding female/male ratio (P=0.046), PT (P=0.022), aPTT (P=0.044), ISTH DIC score (P=0.001), bcr3 (P=0.02) and FLT3-ITD (P=0.028) mutation. The most significant risk factor for venous TE occurrence in multivariate analysis was FLT3-ITD mutation (P=0.034). PAI-1 4G/4G polymorphism was five times more frequent in patients with venous TE than without it (P=0.05). Regarding risk factors for arterial TE we failed to identify any.
  
  
  CONCLUSIONS
  We have demonstrated that APL-related TE rate is higher than previously reported and that weekly D-dimer monitoring might help to identify patients with silent thrombosis. Moreover, our study suggests a possible relationship between venous TE occurrence and several laboratory findings (PT, aPTT, ISTH DIC score, bcr3 isoform, FLT3-ITD mutation and PAI 4G/4G). Prophylactic use of heparin might be considered in patients with ISTH DIC score<5, bcr3 isoform, FLT3-ITD mutation and PAI 4G/4G.
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia. Electronic address: mmg@beotel.net.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Mitrovic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Suvajdzic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Elezovic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Andrija
authors.initials: A
authors.lastname: Bogdanovic
authors.affiliation: Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444aBelgrade, Serbia.
authors.forename: Valentina
authors.initials: V
authors.lastname: Djordjevic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Miljic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia.
authors.forename: Irena
authors.initials: I
authors.lastname: Djunic
authors.affiliation: Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444aBelgrade, Serbia.
authors.forename: Maja
authors.initials: M
authors.lastname: Gvozdenov
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Colovic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia.
authors.forename: Marijana
authors.initials: M
authors.lastname: Virijevic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia.
authors.forename: Danijela
authors.initials: D
authors.lastname: Lekovic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Vidovic
authors.affiliation: Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
authors.forename: Dragica
authors.initials: D
authors.lastname: Tomin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000235:genetics*; D055815:Young Adult
keywords: ATRA; Acute promyelocytic leukemia; PAI-1 4G/5G polymorphism; Risk factors; Thrombotic events