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Hemostatic dysfunction in paraproteinemias and amyloidosis
Maurizio Zangari1, Francesca Elice, Louis Fink
1Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. zangarimaurizio@uams.edu
Seminars in Thrombosis and Hemostasis
|May 26, 2007
Summary
Patients with monoclonal gammopathy, including multiple myeloma (MM), face high risks of thrombosis and bleeding. New research highlights impaired fibrinolysis and protein C system issues as key causes, suggesting anticoagulation may improve survival.
Area of Science:
- Hematology
- Oncology
- Vascular Medicine
Background:
- Patients with monoclonal gammopathies like multiple myeloma (MM) exhibit frequent thrombotic and hemorrhagic complications.
- Chemotherapy and antiangiogenic agents exacerbate cardiovascular risks in these patients.
- Malignancy-associated thrombophilia, driven by cytokines affecting factor VIII and von Willebrand factor, contributes to high thrombosis rates.
Purpose of the Study:
- To elucidate the pathogenetic mechanisms underlying thrombotic complications in monoclonal gammopathies.
- To identify potential diagnostic markers for high-risk patients.
- To explore therapeutic strategies, including anticoagulation, for managing VTE in these conditions.
Main Methods:
- Review of existing literature on thrombotic and hemorrhagic complications in monoclonal gammopathies.
- Analysis of pathogenetic mechanisms including coagulation and fibrinolysis.
- Evaluation of diagnostic coagulation tests and therapeutic interventions.
Main Results:
- Impaired fibrinolysis and transient downregulation of the protein C system are identified as novel pathogenetic mechanisms.
- High levels of factor VIII and von Willebrand factor contribute to malignancy-associated thrombophilia.
- Activated protein C resistance at diagnosis may identify patients benefiting from anticoagulation.
Conclusions:
- Understanding novel pathogenetic mechanisms like impaired fibrinolysis and protein C system dysfunction is crucial.
- Baseline coagulation tests may aid in identifying high-risk patients for anticoagulation.
- Prospective trials evaluating low molecular weight heparin for survival benefit are warranted for these diseases.
