All‐<i>Trans</i> Retinoic Acid (Atra) and Tranexamic Acid: A Potentially Fatal Combination In Acute Promyelocytic Leukaemia

Brown, J. E.; Olujohungbe, Adebayo; Chang, Jee Suk; Ryder, W. David J.; Morganstern, G. R.; Chopra, Rahul; Scarffe, J. H.

doi:10.1046/j.1365-2141.2000.02270-8.x

Cited by 56 publications

(30 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, it was shown that ATRA treatment may be procoagulative [26,27]. The addition of tranexamic acid was found to increase the incidence of thrombotic events [28,29]. In the present study, all patients received ATRA treatment but none took tranexamic acid.…”

Section: Discussionmentioning

confidence: 69%

Acute Promyelocytic Leukemia-Associated Thrombosis

Chang

Kuo²,

Shih³

et al. 2013

Acta Haematol

View full text Add to dashboard Cite

Patients with acute promyelocytic leukemia (APL) are prone to both bleeding and thrombosis. The bleeding complications are well known. In contrast, APL-associated thrombosis is relatively underappreciated. We aimed to explore the issue of APL-associated thrombosis events. In the past 20 years, 127 cases with APL were found in our hospital database. We collected their coagulation laboratory profiles, including leukemia burdens, white blood cell and platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen levels, and disseminated intravascular coagulation scores. Data were compared between patients with or without thrombosis. Clinical outcomes and potential risk factors were obtained for analysis. Ten cases with APL-associated thrombosis were found. The incidence of thrombosis was 7.9% in our cohort. Five patients had cerebral infarction, 5 had catheter-related thrombosis and 1 had acute myocardial infarction. No laboratory data were associated with clinical thrombosis. Three patients died during the induction phase but thrombosis was not the direct cause of death for any of them. We conclude that patients with APL are susceptible to thrombosis in addition to bleeding. Laboratory coagulation parameters did not predict thrombosis in our series. Ischemic stroke and catheter-related thrombosis were the most common events in our Taiwanese cohort. Such a thrombosis pattern is unique and worth further investigation.

show abstract

Section: Discussionmentioning

confidence: 69%

Acute Promyelocytic Leukemia-Associated Thrombosis

Chang

Kuo²,

Shih³

et al. 2013

Acta Haematol

View full text Add to dashboard Cite

show abstract

“…However, the adverse effect of most concern is thrombosis; this is most likely to occur when these drugs are administered to patients with DIC or concurrently with clotting factor concentrates, estrogens, or all-trans retinoic acid. 29 The thrombotic events reported include myocardial infarction and stroke. Thrombi may also obstruct the renal excretory system in patients with genitourinary bleeding.…”

Section: Inhibitors Of Fibrinolysismentioning

confidence: 99%

Management of Bleeding Complications of Hematologic Malignancies

Green

2007

Semin Thromb Hemost

View full text Add to dashboard Cite

Persons with hematologic malignancies bleed for a variety of reasons, including alterations in platelet function and numbers, clotting factor deficiencies, circulating anticoagulants, and defects in vascular integrity. The management of bleeding begins with a full characterization of the hemostatic defect. Vitamin K deficiency always should be considered and excluded by clinical history and laboratory tests. Localized bleeding is treated by packing, topical hemostatic agents, dressings, vessel ligation, laser beam coagulation, or embolization. Platelet transfusions are administered for hemorrhage secondary to severe platelet dysfunction or thrombocytopenia, but usually are not indicated if there is no bleeding, even though platelets may be as low as 10,000/microL. Bleeding due to thrombocytopenia that is refractory to random-donor platelets may respond to cross-matched compatible platelets, or to recombinant factor VIIa (rFVIIa). Fresh frozen plasma is indicated infrequently; bleeding due to coagulopathies is better managed with cryoprecipitate if fibrinogen is low, or with clotting factor concentrates appropriate for the specific clotting factors found to be deficient. rFVIIa or activated prothrombin complex concentrate usually controls hemorrhage due to autoantibodies directed against factor VIII, and acquired von Willebrand's disease may be responsive to desmopressin or intravenous gamma globulin infusion. Antifibrinolytic agents often enhance other hemostatic therapies, but should be withheld if there is genitourinary bleeding or evidence of disseminated intravascular coagulation. Finally, plasmapheresis and immunoadsorption to remove paraproteins may be helpful when other measures fail to curb bleeding.

show abstract

“…11 In primary hyperfibrinolysis and DIC, treatment of the underlying condition is critical. Chemotherapy has shown beneficial effects in metastatic prostate cancer with associated hyperfibrinolysis as seen in our case, as well as shown by others.…”

Section: Discussionmentioning

confidence: 99%