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Semin Thromb Hemost 2007; 33(4): 339-349
DOI: 10.1055/s-2007-976169
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Hemostatic Dysfunction in Paraproteinemias and Amyloidosis

Maurizio Zangari1 , Francesca Elice1 , Louis Fink2 , Guido Tricot1
  • 1Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
  • 2Nevada Cancer Institute, Las Vegas, Nevada
Further Information

Publication History

Publication Date:
24 May 2007 (online)

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ABSTRACT

Thrombotic and hemorrhagic complications frequently have been observed in patients with monoclonal gammopathy, Waldenström macroglobulinemia, amyloidosis, multiple myeloma (MM), and myeloma. Chemotherapy in combination with the use of antiangiogenic agents can further enhance the risk of cardiovascular complications. A malignancy-associated thrombophilic state (in particular, cytokine-induced high levels of factor VIII and von Willebrand factor) can also explain the high rate of thrombosis reported in these patients. Impaired fibrinolysis and a transient downregulation of the protein C system are recently discovered pathogenetic mechanisms. At diagnosis, when the highest VTE risk is present, baseline coagulation tests such activated protein C resistance may be helpful to identify patients who can benefit the most from anticoagulation; with the emerging evidence of a positive effect on survival of low molecular weight heparin, prospective trials are needed in this group of diseases.

KEYWORDS

Myeloma - paraproteinemia - amyloidosis - bleeding diathesis - thrombosis

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Maurizio ZangariM.D. 

Myeloma Institute for Research and Therapy

4301 West Markham, 816 Little Rock, AR 72205

Email: zangarimaurizio@uams.edu

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