Arterial and Venous Thromboses in Patients With Idiopathic (Immunological) Thrombocytopenia: A Possible Contributing Role of Cortisone-Induced Hypercoagulable State

Clin Appl Thromb Hemost. Nov-Dec 2013;19(6):613-8. doi: 10.1177/1076029612452114. Epub 2012 Jul 12.

Abstract

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.

Keywords: arterial; platelets; thrombocytopenia; thrombosis; venous.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Cortisone / administration & dosage
  • Cortisone / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Purpura, Thrombocytopenic, Idiopathic / blood*
  • Purpura, Thrombocytopenic, Idiopathic / immunology
  • Purpura, Thrombocytopenic, Idiopathic / pathology
  • Risk Factors
  • Thrombocytopenia / blood*
  • Thrombocytopenia / immunology
  • Thrombocytopenia / pathology
  • Venous Thrombosis / blood*
  • Venous Thrombosis / chemically induced*
  • Venous Thrombosis / immunology
  • Venous Thrombosis / prevention & control
  • Young Adult

Substances

  • Cortisone