ECE2014 Poster Presentations Steroid metabolism and action (12 abstracts)
A hypercoagulable state associated with intravenous pulse methylprednisolone (MP) therapy in patients with Graves' orbitopathy
Beata Rutkowska 1 , Piotr Miśkiewicz 1 , Katarzyna Trautsolt-Jeziorska 1 , Katarzyna Pirko-Kotela 1 , Justyna Milczarek-Banach 1 , Natalia Wołczańska 1 , Magdalena Jeleńska 2 , Renata Główczyńska 3 & Tomasz Bednarczuk 1
1Department of Endocrinology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland; 2Department of General, Vascular and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland; 31st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Introduction: Chronic exposure to glucocorticoid excess, either endogenous or exogenous, is associated with a hypercoagulable state and a high thromboembolism risk. The underlying mechanism of this phenomenon is still unclear. Clinical studies have indicated various abnormalities of procoagulant, anti-coagulant and fibrynolytic factors, e.g.: alterations of clotting factors (F), plasminogen activator inhibitor (PAI-1), plasminogen, antithrombin. Moreover, other consequences of glucocorticoid excess (obesity, insulin resistance, hypertension, dyslipidemia) can cause vascular and endothelial damage which can independently activate coagulation. However, the risk of a hypercoagulable state during intravenous pulse glucocorticoid therapy remains unknown.
Description of methods/design: The aim of the study was to examine the influence of intravenous methylprednisolone (MP) given once a week for 12 weeks (cumulative dose 4.5 g) in patients with active, moderate to severe Graves’ orbitopathy (GO) on hemostasis. Parameters examined before and after treatment included: FII, FV, FVII, D-dimer, platelets, APTT, PT. Twenty consecutive patients with GO were included into the study (mean age: 52 years), comprising 14 women and 6 men. All patients were euthyroid during the study. There were no history of venous thromboembolism events, 6 patients had well-controlled hypertension and 1 patient impaired glucose tolerance, 11 patients were smokers. No patients were taking medications that affect hemostasis.
Results: Statistically significant increase of FII (P=0.001325), FV (P=0.031824), FVII (P=0.027858) and platelets (P=0.042131) was observed respectively in 90, 75, 70 and 63% of patients. There was observed increase of D-dimer in 55% of patients, and decrease of PT and APTT in 65 and 50% of patients respectively. There were no episodes of clinically overt venous thromboembolism.
Conclusion: High dose intravenous pulse methylprednisolone (MP) in patients with GO may be associated with a hypercoagulable state. In patients with additional risk, prophylactic treatment may be required.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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