Profilaxis y Tratamiento antitrombótico en hemopatías malignas SESIÓN IV. Profilaxis y Tratamiento antitrombótico en hemopatías malignas CUESTIÓN 6. ¿Está aumentando la frecuencia de trombosis en la leucemia promielocítica aguda? ¿Cómo se tratan las trombosis en el contexto hemorrágico de esta enfermedad?
Coagulopatía en LAM3 Falanga A. Medit J Hemat Infect Dis 2011, 3:: e2011068
Coagulopatía en LAM3 Falanga A. Medit J Hemat Infect Dis 2011, 3:: e2011068
Hemorragia y Trombosis en LAM3 Sanz MA. Thromb Res2010; 125: S51-S54
Trombosis en LAM3 Rashidi A. Thromb Res 2010; 131: 281-289
Wun T. Thromb Res 2010; 125 (Suppl 2): S96-S102
Trombosis en LAM3 Breccia M. Leukemia 2007; 21: 79-83.
Trombosis en Leucemia Aguda
Trombosis en LAM3 Las trombosis en la era pre-ATRA eran de un 2% Actualmente pueden llegara a ser de hasta un 19% Rashidi A. Thromb Res 2010; 131: 281-289
Trombosis en LAM3 (i) mere coincidence (e.g. genetic predisposition, prolonged bed rest or immobility) (ii) causation by APL (iii) causation by all-trans retinoic acid (ATRA) (iv) causation by the combination of ATRA and antifibrinolytic agents (v) as a part of the differentiation syndrome caused by ATRA (i.e. ATRA syndrome) Rashidi A. Thromb Res 2010; 131: 281-289
Guidelines for the treatment of coagulopathy in APL patients Initiate ATRA as soon as the diagnosis is suspected based on the clinical picture and morphologic findings in the peripheral blood without waiting for cytogenetic or molecular genetic confirmation Aggressive platelet support to maintain the platelet counts greater than 30,000–50,000/mL Aggressive repletion of fibrinogen with cryoprecipitate to maintain with fibrinogen greater than 150 mg/dL No routine use of heparin No routine use of antifibrinolytic agents Start treatment of the disease with ATRA and chemotherapy for patients who present with a high white blood cell count
Breen KA. Br J Haematol 2011; 156: 24-36