ABSTRACT
Treatment with thalidomide is associated with vascular thrombosis. The effect of thalidomide on platelet activation is unclear, although the use of aspirin is justified for thromboprophylaxis. A study on platelet activation markers was done among multiple myeloma patients receiving thalidomide therapy with warfarin as thromboprophylaxis. Strict criteria and procedure were set to avoid misinterpretation of platelet activation other than due to the thalidomide's effect. Blood specimen pre and post thalidomide therapy were used for flow cytometric analysis. Platelet surface P-selectin, CD62P expression and PAC-1 (antibody that recognizes conformational change of the GPIIb/IIIa complex) were examined by using three-colour flowcytometer. Increased expression marker for PAC-1 was observed after 4 weeks of thalidomide treatment (Pâ<â0.05) indicating one aspect of platelet activation activity seen in these patients. The mechanism of thrombosis by thalidomide is probably multifactorial and one of them is likely through platelet activation. Further study on the affected pathway/s in the platelet activation process would confirm the exact mechanism of thalidomide-induced thrombosis and potential extended usage of this drug in future.
Subject(s)
Antibodies, Monoclonal/metabolism , Immunosuppressive Agents/adverse effects , Multiple Myeloma/drug therapy , Thalidomide/adverse effects , Thrombosis/genetics , Aged , Antibodies, Monoclonal/immunology , Anticoagulants/therapeutic use , Blood Platelets/drug effects , Blood Platelets/immunology , Blood Platelets/pathology , Female , Gene Expression , Humans , Male , Middle Aged , Multiple Myeloma/immunology , Multiple Myeloma/pathology , P-Selectin/genetics , P-Selectin/immunology , P-Selectin/metabolism , Platelet Activation/drug effects , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Platelet Glycoprotein GPIIb-IIIa Complex/immunology , Thrombosis/chemically induced , Thrombosis/immunology , Thrombosis/pathology , Warfarin/therapeutic useABSTRACT
A 24-year-old male patient with refractory Tourette syndrome was treated with deep brain stimulation (DBS) and developed subsequent bilateral subcortical haematomas. Additional blood tests revealed abnormalities of plasma factor XIIIA and tryptophan levels, which may be associated with Tourette syndrome. Neurosurgeons who perform DBS surgery on patients with Tourette syndrome must be aware of possible disastrous complications resulting from factor XIIIA disorders of blood haemostasis. Routine screening for this condition is not typically performed prior to surgery in these patients.
